Provider Demographics
NPI:1255959888
Name:EMPOWERING MINDS COUNSELING AND CONSULTANT SERVICES,LLC
Entity type:Organization
Organization Name:EMPOWERING MINDS COUNSELING AND CONSULTANT SERVICES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LATESHA
Authorized Official - Middle Name:TANISE
Authorized Official - Last Name:MCINNIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, EDS, BC-TMH
Authorized Official - Phone:228-313-6072
Mailing Address - Street 1:1955 POPPS FERRY RD APT 1127BB
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-2031
Mailing Address - Country:US
Mailing Address - Phone:228-313-6072
Mailing Address - Fax:
Practice Address - Street 1:1114 ROBINSON ST # A
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-3842
Practice Address - Country:US
Practice Address - Phone:228-313-6072
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health