Provider Demographics
NPI:1942900634
Name:MIND EMPOWERMENT LLC
Entity Type:Organization
Organization Name:MIND EMPOWERMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:JAPENGA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:623-377-1813
Mailing Address - Street 1:PO BOX 303
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-0303
Mailing Address - Country:US
Mailing Address - Phone:602-529-1463
Mailing Address - Fax:
Practice Address - Street 1:11225 N 28TH DR STE D220C
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-5697
Practice Address - Country:US
Practice Address - Phone:602-529-1463
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty