Provider Demographics
NPI:1558129221
Name:EMBRACING AUTHENTICITY INC
Entity Type:Organization
Organization Name:EMBRACING AUTHENTICITY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLY
Authorized Official - Middle Name:DL
Authorized Official - Last Name:LEBARON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMFT
Authorized Official - Phone:435-915-6398
Mailing Address - Street 1:576 N 470 E
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:UT
Mailing Address - Zip Code:84332-8901
Mailing Address - Country:US
Mailing Address - Phone:435-764-5186
Mailing Address - Fax:
Practice Address - Street 1:95 GOLF COURSE RD STE 105
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-5990
Practice Address - Country:US
Practice Address - Phone:435-915-6398
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty