Provider Demographics
NPI: | 1104681170 |
---|---|
Name: | EMPOWERED FAMILY CONSULTING |
Entity type: | Organization |
Organization Name: | EMPOWERED FAMILY CONSULTING |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | TANNER |
Authorized Official - Middle Name: | LYNN |
Authorized Official - Last Name: | WOODING |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | BCBA, LBA |
Authorized Official - Phone: | 253-948-7149 |
Mailing Address - Street 1: | PO BOX 43 |
Mailing Address - Street 2: | |
Mailing Address - City: | WOODINVILLE |
Mailing Address - State: | WA |
Mailing Address - Zip Code: | 98072-0043 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 17714 INTERURBAN BLVD |
Practice Address - Street 2: | |
Practice Address - City: | SNOHOMISH |
Practice Address - State: | WA |
Practice Address - Zip Code: | 98296-5338 |
Practice Address - Country: | US |
Practice Address - Phone: | 253-948-7149 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2024-02-19 |
Last Update Date: | 2024-10-16 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 103K00000X | Behavioral Health & Social Service Providers | Behavior Analyst | Group - Single Specialty | |
No | 251S00000X | Agencies | Community/Behavioral Health | Group - Single Specialty |