Provider Demographics
NPI:1255924767
Name:EMPOWERED LIFE COUNSELING, PLLC
Entity type:Organization
Organization Name:EMPOWERED LIFE COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:MARONDA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:701-306-8369
Mailing Address - Street 1:1026 31ST AVE W
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-8245
Mailing Address - Country:US
Mailing Address - Phone:701-361-4093
Mailing Address - Fax:
Practice Address - Street 1:4357 13TH AVENUE S SUITE 104
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103
Practice Address - Country:US
Practice Address - Phone:701-306-8369
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-16
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty