Provider Demographics
NPI:1467818948
Name:EMPOWERED: A CENTER FOR SEXUALITY, LLC
Entity Type:Organization
Organization Name:EMPOWERED: A CENTER FOR SEXUALITY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO AND BEHAVIOR ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MAIO
Authorized Official - Suffix:
Authorized Official - Credentials:MSP, BCBA, LBA
Authorized Official - Phone:314-808-8168
Mailing Address - Street 1:8000 BONHOMME AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CLAYTON
Mailing Address - State:MO
Mailing Address - Zip Code:63105-3515
Mailing Address - Country:US
Mailing Address - Phone:314-755-1593
Mailing Address - Fax:314-755-1592
Practice Address - Street 1:8000 BONHOMME AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:CLAYTON
Practice Address - State:MO
Practice Address - Zip Code:63105-3515
Practice Address - Country:US
Practice Address - Phone:314-755-1593
Practice Address - Fax:314-755-1592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-13
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOLC001464774251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health