Provider Demographics
NPI:1306299904
Name:EMPOWERING SYSTEMIC THERAPY
Entity type:Organization
Organization Name:EMPOWERING SYSTEMIC THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEAD CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ETHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SELVIG
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:303-960-4822
Mailing Address - Street 1:80 GARDEN CTR
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-7087
Mailing Address - Country:US
Mailing Address - Phone:303-960-4822
Mailing Address - Fax:
Practice Address - Street 1:80 GARDEN CTR
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-7087
Practice Address - Country:US
Practice Address - Phone:303-960-4822
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-19
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1686251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management