MEDICARE: THE EMPOWERMENT GROUP

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	101YP2500X	Professional Counselor	LPC13764	AZ

General Provider Information

NPI Number	:	1225414915
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE EMPOWERMENT GROUP

Provider Business Mailing Address
First Line	:	10201 S 51ST ST
Second Line	:	STE #130
City	:	PHOENIX
State	:	AZ
Zip	:	85044-5215
Country	:	US
Telephone Number	:	602-525-5783
Fax Number	:

Provider Business Practice Location Address
First Line	:	10201 S 51ST ST
Second Line	:	STE #130
City	:	PHOENIX
State	:	AZ
Zip	:	85044-5215
Country	:	US
Telephone Number	:	602-525-5783
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR / THERAPIST
Name	:	MELISSA COX-PASQUA
Credential	:	LPC, RN
Telephone Number	:	602-525-5783

Provider Enumeration Date	:	08/04/2015
Last Update Date	:	08/04/2015

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