Provider Demographics
NPI:1447996343
Name:EMPOWER PSYCHOTHERAPY, LLC
Entity type:Organization
Organization Name:EMPOWER PSYCHOTHERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:TERENCE
Authorized Official - Last Name:GASTELLE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:301-471-6944
Mailing Address - Street 1:112 N CENTRAL AVE APT 1048
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-2309
Mailing Address - Country:US
Mailing Address - Phone:301-798-4588
Mailing Address - Fax:
Practice Address - Street 1:4153 E STONY MEADOW DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85756-3077
Practice Address - Country:US
Practice Address - Phone:480-291-0769
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-12
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health