Provider Demographics
NPI:1093432171
Name:EMPOWERED HEALING LLC
Entity Type:Organization
Organization Name:EMPOWERED HEALING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER/CLINICAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:LORENA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:989-292-5068
Mailing Address - Street 1:8000 SOUTHERN PINES DR
Mailing Address - Street 2:
Mailing Address - City:MAINEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45039-9439
Mailing Address - Country:US
Mailing Address - Phone:989-292-5068
Mailing Address - Fax:
Practice Address - Street 1:5720 GATEWAY STE 102
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-1891
Practice Address - Country:US
Practice Address - Phone:513-549-1598
Practice Address - Fax:513-480-8360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-20
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0397344Medicaid