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NPI Code Detail

MEDICARE: EMPOWERMENT CLINICAL AND CONSULTING SERVICES, LLC

MEDICARE: EMPOWERMENT CLINICAL AND CONSULTING SERVICES, 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
1251C00000XDevelopmentally Disabled Services Day Training Agency
2251S00000XCommunity/Behavioral Health Agency
3261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)
4320600000XIntellectual and/or Developmental Disabilities Residential Treatment Facility
5320800000XMental Illness Community Based Residential Treatment Facility
6251B00000XCase Management Agency

General Provider Information

NPI Number : 1255793048
Entity Type Code : Organization
Provider Name (Legal Business Name) : EMPOWERMENT CLINICAL AND CONSULTING SERVICES, LLC
Provider Business Mailing Address
First Line : 9500 RAY WHITE RD
Second Line :
City : FORT WORTH
State : TX
Zip : 76244-6000
Country : US
Telephone Number : 804-922-1189
Fax Number :
Provider Business Practice Location Address
First Line : 9500 RAY WHITE RD STE 200
Second Line :
City : FORT WORTH
State : TX
Zip : 76244-9105
Country : US
Telephone Number : 817-329-5074
Fax Number :
Authorized Official
Title or Position : CEO / OWNER
Name : MR. TERRANCE EDWARDS
Credential :
Telephone Number : 804-922-1189
Provider Enumeration Date : 03/22/2016
Last Update Date : 12/14/2023

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