Organization
FIT4 AN EMPOWERED LIFE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LAJUANA E MITCHELL LPC (OWNER)
(313) 590-5253
Entity
Organization
Contact information
Practice address
4802 E RAY RD STE 23-266, PHOENIX, AZ 85044-6405
(313) 590-5253
(602) 491-2677
Mailing address
4802 E RAY RD SUITE 23-266, PHOENIX, AZ 85076-1492
(313) 590-5253
(602) 491-2677
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
251B00000X
Case Management Agency
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
251E00000X
Home Health Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261Q00000X
Clinic/Center
—
—
261QC1800X
Corporate Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
261QR0400X
Rehabilitation Clinic/Center
—
—
347C00000X
Private Vehicle
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
23098837
ENTITY ID
AZ
05
—
277387
—
AZ
Enumeration date
06/23/2020
Last updated
03/30/2021
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