Provider Demographics
NPI:1952542037
Name:EMPOWERMENT THERAPY CENTER, LLC
Entity Type:Organization
Organization Name:EMPOWERMENT THERAPY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:719-329-1900
Mailing Address - Street 1:5855 LEHMAN DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-3423
Mailing Address - Country:US
Mailing Address - Phone:719-329-1900
Mailing Address - Fax:719-329-1901
Practice Address - Street 1:5855 LEHMAN DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-3423
Practice Address - Country:US
Practice Address - Phone:719-329-1900
Practice Address - Fax:719-329-1901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-18
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7403101YA0400X
CO427101YA0400X
CO4606101YP2500X, 251S00000X
CO11132101YP2500X, 251S00000X
CO2060101YP2500X, 251S00000X
CO4486101YP2500X, 251S00000X
CO6395101YP2500X, 251S00000X
CO2896103T00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO612002Medicaid
CO698423Medicaid
CO713204Medicaid
CO136998Medicaid