Provider Demographics
NPI:1760059521
Name:EMPOWERED WELLNESS LLC
Entity Type:Organization
Organization Name:EMPOWERED WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LIMHP
Authorized Official - Prefix:
Authorized Official - First Name:CRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PATENT
Authorized Official - Suffix:
Authorized Official - Credentials:LIMHP
Authorized Official - Phone:402-316-2055
Mailing Address - Street 1:301 S 70TH ST STE 350
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2472
Mailing Address - Country:US
Mailing Address - Phone:402-316-2055
Mailing Address - Fax:
Practice Address - Street 1:301 S 70TH ST STE 350
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2472
Practice Address - Country:US
Practice Address - Phone:402-316-2055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026877300Medicaid