Provider Demographics
NPI:1326597808
Name:EMPOWERMENT & TRANSFORMATION, INC.
Entity Type:Organization
Organization Name:EMPOWERMENT & TRANSFORMATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:FAHLSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:503-409-5086
Mailing Address - Street 1:PO BOX 2893
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97308-2893
Mailing Address - Country:US
Mailing Address - Phone:503-409-5086
Mailing Address - Fax:503-967-6980
Practice Address - Street 1:189 LIBERTY ST NE
Practice Address - Street 2:SUITE 202
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3682
Practice Address - Country:US
Practice Address - Phone:503-409-5086
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT0724106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty