MEDICARE: EMPOWERED LIVING COUNSELING AND LIFE COACHING, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1023579778
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMPOWERED LIVING COUNSELING AND LIFE COACHING, LLC

Provider Business Mailing Address
First Line	:	2525 MOODY RD STE 105
Second Line	:
City	:	WARNER ROBINS
State	:	GA
Zip	:	31088-6110
Country	:	US
Telephone Number	:	478-202-8947
Fax Number	:	888-540-0763

Provider Business Practice Location Address
First Line	:	2525 MOODY RD STE 105
Second Line	:
City	:	WARNER ROBINS
State	:	GA
Zip	:	31088-6110
Country	:	US
Telephone Number	:	478-202-8947
Fax Number	:	888-540-0763

Authorized Official
Title or Position	:	OWNER
Name	:	JENNIFER TRAWICK
Credential	:	LPC
Telephone Number	:	478-390-8408

Provider Enumeration Date	:	03/26/2019
Last Update Date	:	09/07/2023

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