MEDICARE: EMPOWER TODAY 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	:	1528763067
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMPOWER TODAY THERAPY LLC

Provider Business Mailing Address
First Line	:	1992 LEWIS TURNER BLVD STE 1132
Second Line	:
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-1255
Country	:	US
Telephone Number	:	850-332-4127
Fax Number	:

Provider Business Practice Location Address
First Line	:	1992 LEWIS TURNER BLVD STE 1132
Second Line	:
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-1255
Country	:	US
Telephone Number	:	850-332-4127
Fax Number	:

Authorized Official
Title or Position	:	MGR
Name	:	MRS. STEPHANIE BERLYN GUISE
Credential	:	LCSW
Telephone Number	:	972-837-0065

Provider Enumeration Date	:	04/03/2023
Last Update Date	:	04/03/2023

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