Provider Demographics
NPI:1538700273
Name:EMPOWER FAMILY THERAPY, LLC.
Entity Type:Organization
Organization Name:EMPOWER FAMILY THERAPY, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA (TINA)
Authorized Official - Middle Name:THERAPY
Authorized Official - Last Name:SHRADER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:773-340-2336
Mailing Address - Street 1:137 N OAK PARK AVE STE 123
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1300
Mailing Address - Country:US
Mailing Address - Phone:773-340-2336
Mailing Address - Fax:
Practice Address - Street 1:137 N OAK PARK AVE STE 123
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1300
Practice Address - Country:US
Practice Address - Phone:773-340-2336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE