Provider Demographics
NPI:1174013254
Name:EMPOWERING CHANGE COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:EMPOWERING CHANGE COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:602-699-5750
Mailing Address - Street 1:6197 S RURAL RD STE 102
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-2909
Mailing Address - Country:US
Mailing Address - Phone:602-699-5750
Mailing Address - Fax:
Practice Address - Street 1:6197 S RURAL RD STE 102
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-2909
Practice Address - Country:US
Practice Address - Phone:602-699-5750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-15
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)