Provider Demographics
NPI:1780564831
Name:EMPOWER WELL THERAPY PLLC
Entity type:Organization
Organization Name:EMPOWER WELL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GABRIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:708-897-7756
Mailing Address - Street 1:11361 E 4000S RD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE TOWNSHIP
Mailing Address - State:IL
Mailing Address - Zip Code:60958-4919
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11361 E 4000S RD
Practice Address - Street 2:
Practice Address - City:PEMBROKE TOWNSHIP
Practice Address - State:IL
Practice Address - Zip Code:60958-4919
Practice Address - Country:US
Practice Address - Phone:708-897-7756
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)