Provider Demographics
NPI:1518619956
Name:EMPOWER COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:EMPOWER COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:612-296-1514
Mailing Address - Street 1:609 PARKHILL DR APT 18
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-9112
Mailing Address - Country:US
Mailing Address - Phone:612-296-1514
Mailing Address - Fax:
Practice Address - Street 1:733 W MARKET ST STE 104
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44303-1088
Practice Address - Country:US
Practice Address - Phone:330-400-4225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-26
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0372439Medicaid