Provider Demographics
NPI:1649951948
Name:EMPOWERED SOUL PSYCHOLOGICAL SERVICES LLC
Entity type:Organization
Organization Name:EMPOWERED SOUL PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FALESA
Authorized Official - Middle Name:
Authorized Official - Last Name:IVORY
Authorized Official - Suffix:
Authorized Official - Credentials:LP
Authorized Official - Phone:402-261-3714
Mailing Address - Street 1:8101 O ST STE 300
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2647
Mailing Address - Country:US
Mailing Address - Phone:402-261-3714
Mailing Address - Fax:
Practice Address - Street 1:8101 O ST STE 300
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2647
Practice Address - Country:US
Practice Address - Phone:402-261-3714
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-28
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty