NPIMap

Organization Active NPI

Empowering Minds 4 Change, LLC

  • Behavior Analyst
  • Woodbridge, VA
National Provider Identifier
1275102691
Registry record updated Sep 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
Legal business name
EMPOWERING MINDS 4 CHANGE, LLC
Doing business as
Empowering Minds 4 Change, LLC.
Practice address
4301 Stretton Farm CT
Woodbridge, VA 22192-5564
Phone
(571) 580-9160
NPI assigned
Jun 21, 2021
Last updated
Sep 14, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2023

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

Authorized official

Name
Jennifer Clements, BCBA, LBA TLLPNPI 1073972774
Title
Board Certified Behavior Analyst
Phone
(248) 704-4751

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X
Behavior Analyst 103K00000X Primary

Addresses

Primary practice location

4301 Stretton Farm CT
Woodbridge, VA 22192-5564

Mailing address

4301 Stretton Farm CT
Woodbridge, VA 22192-5564
Phone (571) 580-9160

Other names 1

  • Empowering Minds 4 Change, LLC. Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1624233600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694649600000",
    "number": "1275102691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4301 STRETTON FARM CT",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221925564",
            "telephone_number": "571-580-9160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4301 STRETTON FARM CT",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221925564",
            "telephone_number": "571-580-9160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMPOWERING MINDS 4 CHANGE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-21",
        "last_updated": "2023-09-14",
        "certification_date": "2023-09-14",
        "status": "A",
        "authorized_official_last_name": "CLEMENTS",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "BOARD CERTIFIED BEHAVIOR ANALYST",
        "authorized_official_telephone_number": "248-704-4751",
        "authorized_official_credential": "BCBA, LBA TLLP"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Empowering Minds 4 Change, LLC.",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Empowering Minds 4 Change, LLC.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Woodbridge, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 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.