MEDICARE: EMPOWERED MINDS THERAPY, 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	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1205630605
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMPOWERED MINDS THERAPY, LLC

Provider Business Mailing Address
First Line	:	5020 RUSSELL ST
Second Line	:
City	:	MIDLAND
State	:	MI
Zip	:	48640-7235
Country	:	US
Telephone Number	:	989-890-7042
Fax Number	:

Provider Business Practice Location Address
First Line	:	5020 RUSSELL ST
Second Line	:
City	:	MIDLAND
State	:	MI
Zip	:	48640-7235
Country	:	US
Telephone Number	:	989-890-7042
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CASSANDRA HERZBERGER
Credential	:	LMSW
Telephone Number	:	989-890-7042

Provider Enumeration Date	:	04/03/2025
Last Update Date	:	04/03/2025

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