Provider Demographics
NPI:1992189070
Name:EMPOWERED LIFE COUNSELING, INC
Entity Type:Organization
Organization Name:EMPOWERED LIFE COUNSELING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:REMY
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:954-270-9378
Mailing Address - Street 1:3319 INVERRARY BLVD W
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33319-4953
Mailing Address - Country:US
Mailing Address - Phone:954-270-9378
Mailing Address - Fax:
Practice Address - Street 1:3319 INVERRARY BLVD W
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33319-4953
Practice Address - Country:US
Practice Address - Phone:954-270-9378
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-17
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 10889101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH 10889OtherLICENSE NUMBER