MEDICARE: EMPOWERED LIBERATION 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	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1750146254
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMPOWERED LIBERATION PLLC

Provider Business Mailing Address
First Line	:	23708 W WARREN ST APT 1
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-2348
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	26711 WOODWARD AVE STE 208
Second Line	:
City	:	HUNTINGTON WOODS
State	:	MI
Zip	:	48070-1368
Country	:	US
Telephone Number	:	734-512-6835
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL THERAPIST
Name	:	UZMA ANWAR
Credential	:	LLMSW
Telephone Number	:	734-512-6835

Provider Enumeration Date	:	02/14/2024
Last Update Date	:	02/14/2024

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