MEDICARE: EMPOWERED PATHWAYS PNW, PLLC

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1720920945
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMPOWERED PATHWAYS PNW, PLLC

Provider Business Mailing Address
First Line	:	5700 6TH AVE S STE 203
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98108-2510
Country	:	US
Telephone Number	:	808-419-8105
Fax Number	:

Provider Business Practice Location Address
First Line	:	5700 6TH AVE S STE 203
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98108-2510
Country	:	US
Telephone Number	:	808-419-8105
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PSYCHOTHERAPIST
Name	:	LISA M. FANNING
Credential	:	LMHC
Telephone Number	:	808-419-8105

Provider Enumeration Date	:	04/07/2026
Last Update Date	:	04/07/2026

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