Provider Demographics
NPI:1972860203
Name:EMPOWERED ALLIANCE THERAPY
Entity Type:Organization
Organization Name:EMPOWERED ALLIANCE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STARLENE
Authorized Official - Middle Name:M
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, CADC
Authorized Official - Phone:312-857-8282
Mailing Address - Street 1:143 FIRST ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BATAVIA
Mailing Address - State:IL
Mailing Address - Zip Code:60510-3101
Mailing Address - Country:US
Mailing Address - Phone:312-857-8282
Mailing Address - Fax:630-897-8002
Practice Address - Street 1:143 FIRST ST
Practice Address - Street 2:SUITE 202
Practice Address - City:BATAVIA
Practice Address - State:IL
Practice Address - Zip Code:60510-3101
Practice Address - Country:US
Practice Address - Phone:312-857-8282
Practice Address - Fax:630-897-8002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-11
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL40723917261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)