| Empowered Living Psychological Services, Inc. | |
|
9113 Foothill Blvd Ste 130 Rancho Cucamonga CA 91730-6565 | |
| (909) 652-0361 | |
| (909) 652-0241 |
| Full Name | Empowered Living Psychological Services, Inc. |
|---|---|
| Speciality | Psychologist |
| Location | 9113 Foothill Blvd Ste 130, Rancho Cucamonga, California |
| Authorized Official Name and Position | Stefanie Lockhart-pettaway (CEO/ CLINICAL PSYCHOLOGIST) |
| Authorized Official Contact | 9096520361 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Empowered Living Psychological Services, Inc. 9113 Foothill Blvd Ste 130 Rancho Cucamonga CA 91730-6565 Ph: (909) 652-0361 | Empowered Living Psychological Services, Inc. 9113 Foothill Blvd Ste 130 Rancho Cucamonga CA 91730-6565 Ph: (909) 652-0361 |
| NPI Number | 1831653021 |
|---|---|
| Provider Enumeration Date | 01/22/2019 |
| Last Update Date | 04/28/2021 |
| Certification Date | 04/28/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831653021 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
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