=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972395770
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EMPOWERED HEALING THERAPY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/19/2025
-----------------------------------------------------
Last Update Date | 05/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4401 WESTOWN PKWY STE 301
-----------------------------------------------------
City | WEST DES MOINES
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50266-6721
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-800-9515
-----------------------------------------------------
Fax | 515-335-0440
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4401 WESTOWN PKWY STE 301
-----------------------------------------------------
City | WEST DES MOINES
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50266-6721
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-800-9515
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LMFT
-----------------------------------------------------
Name | MRS. MEGAN JO DEVORE
-----------------------------------------------------
Credential | LMFT
-----------------------------------------------------
Telephone | 515-800-9515
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------