Provider Demographics
NPI:1407555964
Name:EMBODIED WELLNESS CENTER, PLLC
Entity Type:Organization
Organization Name:EMBODIED WELLNESS CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER, PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCPC
Authorized Official - Phone:224-404-0164
Mailing Address - Street 1:2506 N CLARK ST # 171
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1848
Mailing Address - Country:US
Mailing Address - Phone:224-404-0164
Mailing Address - Fax:
Practice Address - Street 1:70 W HURON ST APT 1508
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-5344
Practice Address - Country:US
Practice Address - Phone:224-404-0164
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-23
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty