Provider Demographics
NPI:1518679232
Name:EMPOWERMENT PLUS THERAPY PRACTICE LLC
Entity Type:Organization
Organization Name:EMPOWERMENT PLUS THERAPY PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:ETHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MOGILEVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:313-338-8643
Mailing Address - Street 1:15350 N COMMERCE DR STE 204
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48120-1234
Mailing Address - Country:US
Mailing Address - Phone:313-338-8643
Mailing Address - Fax:
Practice Address - Street 1:15350 N COMMERCE DR STE 204
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48120-1234
Practice Address - Country:US
Practice Address - Phone:313-338-8643
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-14
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1063037190Medicaid