Provider Demographics
NPI:1679732887
Name:EMPOWER THERAPEUTIC SUPPORT SERVICES PLLC
Entity Type:Organization
Organization Name:EMPOWER THERAPEUTIC SUPPORT SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CEDRIC
Authorized Official - Middle Name:
Authorized Official - Last Name:WEATHERSPOON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:612-233-0373
Mailing Address - Street 1:227 COLFAX AVE N SUITE 15
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55405
Mailing Address - Country:US
Mailing Address - Phone:612-223-0373
Mailing Address - Fax:612-223-0373
Practice Address - Street 1:227 COLFAX AVE N SUITE 15
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55405
Practice Address - Country:US
Practice Address - Phone:612-223-0373
Practice Address - Fax:612-781-2428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-03
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1679732887Medicaid