Provider Demographics
NPI:1629851258
Name:EMPOWERED FAMILY THERAPY SERVICES
Entity Type:Organization
Organization Name:EMPOWERED FAMILY THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NATASHA
Authorized Official - Middle Name:NICHOLE
Authorized Official - Last Name:CERRILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-416-4866
Mailing Address - Street 1:121 W MAIN ST STE G
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95380-4845
Mailing Address - Country:US
Mailing Address - Phone:209-416-4866
Mailing Address - Fax:209-301-7817
Practice Address - Street 1:121 W MAIN ST STE G
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95380-4845
Practice Address - Country:US
Practice Address - Phone:209-416-4866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-16
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health