Provider Demographics
NPI:1083310940
Name:EMBRACE MENTAL WELLNESS
Entity Type:Organization
Organization Name:EMBRACE MENTAL WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMFT
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENGTSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:651-253-7262
Mailing Address - Street 1:19884 POLK ST NW
Mailing Address - Street 2:
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-2276
Mailing Address - Country:US
Mailing Address - Phone:651-253-7262
Mailing Address - Fax:
Practice Address - Street 1:657 MAIN ST NW
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-1584
Practice Address - Country:US
Practice Address - Phone:651-253-7262
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty