Provider Demographics
NPI:1649748286
Name:EMPOWERED CHANGE: COUNSELING & EDUCATION
Entity Type:Organization
Organization Name:EMPOWERED CHANGE: COUNSELING & EDUCATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:A
Authorized Official - Last Name:WIENECKE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, LAC
Authorized Official - Phone:720-443-1278
Mailing Address - Street 1:800 WASHINGTON AVE APT D
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-5815
Mailing Address - Country:US
Mailing Address - Phone:720-443-1278
Mailing Address - Fax:
Practice Address - Street 1:800 WASHINGTON AVE
Practice Address - Street 2:SUITE D
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401
Practice Address - Country:US
Practice Address - Phone:720-443-1278
Practice Address - Fax:720-368-5056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-12
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty