Provider Demographics
NPI:1093466047
Name:EMBRACE YOUR HEALING BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:EMBRACE YOUR HEALING BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUD/CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:TILMON
Authorized Official - Suffix:
Authorized Official - Credentials:RADT, MA
Authorized Official - Phone:661-246-5122
Mailing Address - Street 1:15720 VENTURA BLVD STE 609
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-4733
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15720 VENTURA BLVD STE 609
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-4733
Practice Address - Country:US
Practice Address - Phone:833-736-2722
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-11
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty