MEDICARE: EMPOWERING GENERATIONS, 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	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1780332098
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMPOWERING GENERATIONS, LLC

Provider Business Mailing Address
First Line	:	7013 FOSSIL RIM ST
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89084-4028
Country	:	US
Telephone Number	:	702-573-9715
Fax Number	:

Provider Business Practice Location Address
First Line	:	7013 FOSSIL RIM ST
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89084-4028
Country	:	US
Telephone Number	:	702-573-9715
Fax Number	:

Authorized Official
Title or Position	:	OWNER / DIRECT SUPERVISOR
Name	:	HERNORIA P CHILDRESS SMITH
Credential	:
Telephone Number	:	702-573-9715

Provider Enumeration Date	:	03/15/2022
Last Update Date	:	03/15/2022

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Directions to “EMPOWERING GENERATIONS, LLC ” Practice Location

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