Provider Demographics
NPI:1720745011
Name:EMPOWER TCT LLC
Entity Type:Organization
Organization Name:EMPOWER TCT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LARISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:TRAGA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:805-266-3231
Mailing Address - Street 1:1741 WINCHESTER WAY
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-2665
Mailing Address - Country:US
Mailing Address - Phone:805-266-3231
Mailing Address - Fax:
Practice Address - Street 1:330 JAMES WAY STE 180
Practice Address - Street 2:
Practice Address - City:PISMO BEACH
Practice Address - State:CA
Practice Address - Zip Code:93449-2891
Practice Address - Country:US
Practice Address - Phone:805-266-3231
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-21
Last Update Date:2021-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)