Provider Demographics
NPI:1194473082
Name:EMBODIMENT COUNSELING LLC
Entity Type:Organization
Organization Name:EMBODIMENT COUNSELING LLC
Other - Org Name:IRMA JESSICA SALGADO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:IRMA JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:SALGADO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:505-372-4665
Mailing Address - Street 1:120 ALISO DR SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-2693
Mailing Address - Country:US
Mailing Address - Phone:505-372-4665
Mailing Address - Fax:
Practice Address - Street 1:9180 COORS BLVD NW APT 2905
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-3122
Practice Address - Country:US
Practice Address - Phone:505-929-9224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-10
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM29277213Medicaid