Provider Demographics
NPI:1073172425
Name:LIVE EMPOWERED, LLC
Entity Type:Organization
Organization Name:LIVE EMPOWERED, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KEESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHEPRA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:973-775-9058
Mailing Address - Street 1:16 GUILFORD CT
Mailing Address - Street 2:
Mailing Address - City:MORRIS PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07950-1256
Mailing Address - Country:US
Mailing Address - Phone:973-775-9058
Mailing Address - Fax:
Practice Address - Street 1:16 GUILFORD CT
Practice Address - Street 2:
Practice Address - City:MORRIS PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07950-1256
Practice Address - Country:US
Practice Address - Phone:973-775-9058
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty