Provider Demographics
NPI:1598439192
Name:EMBODIED TRAUMA THERAPY, LLC
Entity Type:Organization
Organization Name:EMBODIED TRAUMA THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:CMHC
Authorized Official - Phone:801-940-1136
Mailing Address - Street 1:1441 S 1175 E
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84404-5988
Mailing Address - Country:US
Mailing Address - Phone:801-940-1136
Mailing Address - Fax:801-452-6730
Practice Address - Street 1:972 CHAMBERS ST STE 7
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-4873
Practice Address - Country:US
Practice Address - Phone:385-449-1188
Practice Address - Fax:801-452-6730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-06
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health