Provider Demographics
NPI:1134301815
Name:SELF EMPOWERMENT CENTER, P.C.
Entity Type:Organization
Organization Name:SELF EMPOWERMENT CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ASIF
Authorized Official - Middle Name:A
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:630-774-8316
Mailing Address - Street 1:1751 S NAPERVILLE RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-5896
Mailing Address - Country:US
Mailing Address - Phone:630-774-8316
Mailing Address - Fax:630-690-3353
Practice Address - Street 1:1751 S NAPERVILLE RD
Practice Address - Street 2:SUITE 207
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60189-5896
Practice Address - Country:US
Practice Address - Phone:630-774-8316
Practice Address - Fax:630-690-3353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2008-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-005733261QM0850X
IL071-005466261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01623115OtherBLUE CROSS BLUE SHIELD