Empowered Life Counseling, PLLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

EMPOWERED LIFE COUNSELING, PLLC

Practice address

4357 13TH Avenue S Suite 104
Fargo, ND 58103

Phone

(701) 306-8369

NPI assigned

Feb 16, 2021

Last updated

Feb 16, 2021By 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

Maronda Sue Robertson, LPCCNPI 1689862112

Title

Licensed Professional Counselor

Phone

(701) 306-8369

Specialties & licenses 1

Addresses

Locations

Practitioners 2

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.

• Maronda Robertson, LPC

  • Addiction (Substance Use Disorder) Counselor
  • Fargo, ND
  • NPI 1689862112

  Mental Health

  NPD Authorized official
• Thomas Kenneth Dubbels, M.S., LPC

  • Mental Health Counselor
  • Fargo, ND
  • NPI 1740172550
  NPD

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

{
    "created_epoch": "1613433600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613433600000",
    "number": "1255924767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1026 31ST AVE W",
            "city": "WEST FARGO",
            "state": "ND",
            "postal_code": "580788245",
            "telephone_number": "701-361-4093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4357 13TH AVENUE S SUITE 104",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "58103",
            "telephone_number": "701-306-8369"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMPOWERED LIFE COUNSELING, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-16",
        "last_updated": "2021-02-16",
        "certification_date": "2021-02-11",
        "status": "A",
        "authorized_official_last_name": "ROBERTSON",
        "authorized_official_first_name": "MARONDA",
        "authorized_official_middle_name": "SUE",
        "authorized_official_title_or_position": "LICENSED PROFESSIONAL COUNSELOR",
        "authorized_official_telephone_number": "701-306-8369",
        "authorized_official_credential": "LPCC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2021; 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.