Provider Demographics
NPI:1235903782
Name:AUTHENTICALLY EMPOWERED THERAPEUTIC SERVICES PLLC
Entity Type:Organization
Organization Name:AUTHENTICALLY EMPOWERED THERAPEUTIC SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC LCDC
Authorized Official - Phone:214-302-9341
Mailing Address - Street 1:2605 SAGEBRUSH DR STE 204
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-2739
Mailing Address - Country:US
Mailing Address - Phone:214-302-9341
Mailing Address - Fax:
Practice Address - Street 1:2605 SAGEBRUSH DR STE 204
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-2739
Practice Address - Country:US
Practice Address - Phone:214-302-9341
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-14
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty