MEDICARE: EMPOWERED WELLNESS COUNSELING, 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1821642414
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMPOWERED WELLNESS COUNSELING, LLC

Provider Business Mailing Address
First Line	:	107 N BROAD ST STE 308
Second Line	:
City	:	DOYLESTOWN
State	:	PA
Zip	:	18901-3755
Country	:	US
Telephone Number	:	267-755-8633
Fax Number	:

Provider Business Practice Location Address
First Line	:	107 N BROAD ST
Second Line	:
City	:	DOYLESTOWN
State	:	PA
Zip	:	18901-3755
Country	:	US
Telephone Number	:	215-696-3689
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	VALERIE FAHIE
Credential	:
Telephone Number	:	267-755-8633

Provider Enumeration Date	:	07/31/2019
Last Update Date	:	10/15/2019

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