Provider Demographics
NPI:1841679545
Name:EMPOWERED LIFE COUNSELING, PLLC
Entity type:Organization
Organization Name:EMPOWERED LIFE COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALISA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:918-991-5538
Mailing Address - Street 1:5800 E SKELLY DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-6471
Mailing Address - Country:US
Mailing Address - Phone:918-991-5538
Mailing Address - Fax:918-271-5065
Practice Address - Street 1:5800 E SKELLY DR
Practice Address - Street 2:SUITE 105
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-6471
Practice Address - Country:US
Practice Address - Phone:918-991-5538
Practice Address - Fax:918-271-5065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-27
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5181101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200431990AMedicaid