Provider Demographics
NPI:1083487631
Name:EMPOWERED PATHWAYS, LLC
Entity Type:Organization
Organization Name:EMPOWERED PATHWAYS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:KOPP
Authorized Official - Suffix:
Authorized Official - Credentials:MA, BCBA, IBA, LBA
Authorized Official - Phone:228-217-2997
Mailing Address - Street 1:1206 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-2815
Mailing Address - Country:US
Mailing Address - Phone:228-217-2997
Mailing Address - Fax:228-250-1399
Practice Address - Street 1:1206 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-2815
Practice Address - Country:US
Practice Address - Phone:228-217-2997
Practice Address - Fax:228-250-1399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty