Provider Demographics
NPI:1609689389
Name:EMPOWERED WELLNESS JOURNEY LLC
Entity type:Organization
Organization Name:EMPOWERED WELLNESS JOURNEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-915-4843
Mailing Address - Street 1:1292 HIGH ST # 1025
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3238
Mailing Address - Country:US
Mailing Address - Phone:458-206-4385
Mailing Address - Fax:
Practice Address - Street 1:4145 SW WATSON AVE
Practice Address - Street 2:SUITE 350
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-2191
Practice Address - Country:US
Practice Address - Phone:458-206-4385
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-28
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty