Provider Demographics
NPI:1487212064
Name:EMPOWERED THERAPIES & EDUCATION LLC
Entity Type:Organization
Organization Name:EMPOWERED THERAPIES & EDUCATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIETZLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-439-0660
Mailing Address - Street 1:700 RAYOVAC DRIVE
Mailing Address - Street 2:SUITE #320
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-2128
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:700 RAYOVAC DRIVE
Practice Address - Street 2:SUITE #320
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-2128
Practice Address - Country:US
Practice Address - Phone:715-439-0660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-30
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty