| Empowered Behavioral And Clinical Services Llc | |
|
7550 Market Place Dr Eden Prairie MN 55344-3636 | |
| (734) 337-0959 | |
| Not Available |
| Full Name | Empowered Behavioral And Clinical Services Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 7550 Market Place Dr, Eden Prairie, Minnesota |
| Authorized Official Name and Position | Rukiya Hassan (OWNER) |
| Authorized Official Contact | 7343370959 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Empowered Behavioral And Clinical Services Llc 7550 Market Place Dr Eden Prairie MN 55344-3636 Ph: (734) 337-0959 | Empowered Behavioral And Clinical Services Llc 7550 Market Place Dr Eden Prairie MN 55344-3636 Ph: (734) 337-0959 |
| NPI Number | 1801503271 |
|---|---|
| Provider Enumeration Date | 11/03/2022 |
| Last Update Date | 12/20/2022 |
| Certification Date | 12/20/2022 |
| Medicare PECOS PAC ID | 9133599541 |
|---|---|
| Medicare Enrollment ID | O20221229001959 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801503271 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Secondary |
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Primary |
| Provider Name | Rukiya Hassan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1831702265 PECOS PAC ID: 0042680456 Enrollment ID: I20221229002031 |
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