Provider Demographics
NPI:1437643731
Name:EMPOWERED LIVING CONSULTING CORP
Entity Type:Organization
Organization Name:EMPOWERED LIVING CONSULTING CORP
Other - Org Name:EMPOWERED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RANADA
Authorized Official - Middle Name:
Authorized Official - Last Name:DALTON
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:317-969-5694
Mailing Address - Street 1:1144 W 30TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46208-4929
Mailing Address - Country:US
Mailing Address - Phone:317-969-5694
Mailing Address - Fax:317-663-1000
Practice Address - Street 1:1144 W 30TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46208-4929
Practice Address - Country:US
Practice Address - Phone:317-969-5694
Practice Address - Fax:317-663-1000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-20
Last Update Date:2020-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39003303A101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000001285099OtherANTHEM