Provider Demographics
NPI:1386229201
Name:EMPOWERED FREEDOM COUNSELING, PLLC
Entity Type:Organization
Organization Name:EMPOWERED FREEDOM COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, LPC
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:J
Authorized Official - Last Name:PETERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, NCC, ACS
Authorized Official - Phone:720-608-1603
Mailing Address - Street 1:8462 ARTESIAN SPRINGS PT
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-4725
Mailing Address - Country:US
Mailing Address - Phone:719-213-5496
Mailing Address - Fax:
Practice Address - Street 1:7345 ADVENTURE WAY
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-5000
Practice Address - Country:US
Practice Address - Phone:720-608-1603
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-11
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000178609Medicaid
14076240OtherCAQH