Empowered Living Collective LLC

Primary specialty

PsychologistTaxonomy code 103T00000X

Legal business name

EMPOWERED LIVING COLLECTIVE LLC

Practice address

8354 E Northfield Blvd Ste 314
Denver, CO 80238-3131

Phone

(720) 248-8633

NPI assigned

Nov 30, 2022

Last updated

Jan 9, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Anahita Lake-Khosravi, PSYDNPI 1922524701

Title

Co-Owner

Phone

(720) 248-8633

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Anahita Lake-Khosravi

  • Psychologist
  • Denver, CO
  • NPI 1922524701
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1669766400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673222400000",
    "number": "1235849365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8354 NORTHFIELD BLVD",
            "address_2": "BUILDING G SUITE 3700",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802383131",
            "telephone_number": "720-248-8633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8354 E NORTHFIELD BLVD STE 314",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802383131",
            "telephone_number": "720-248-8633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMPOWERED LIVING COLLECTIVE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-30",
        "last_updated": "2023-01-09",
        "certification_date": "2023-01-09",
        "status": "A",
        "authorized_official_last_name": "LAKE-KHOSRAVI",
        "authorized_official_first_name": "ANAHITA",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "720-248-8633",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9000210453",
            "state": "CO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.empoweredlivingcollective.com",
            "affiliation": "N",
            "address_1": "8354 E Northfield Blvd Ste 314",
            "city": "Denver",
            "state": "CO",
            "country_code": "US",
            "postal_code": "802383131",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Psychologist in Denver, CO
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.