Provider Demographics
NPI:1851003826
Name:EMBODIED-WELLBEING LIMITED LIABILITY COMPANY
Entity Type:Organization
Organization Name:EMBODIED-WELLBEING LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:NEILITZ
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:920-521-8940
Mailing Address - Street 1:2701 LARSEN RD # BA109
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54303-4863
Mailing Address - Country:US
Mailing Address - Phone:920-521-8940
Mailing Address - Fax:
Practice Address - Street 1:2701 LARSEN RD # BA109
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54303-4863
Practice Address - Country:US
Practice Address - Phone:920-521-8940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-21
Last Update Date:2023-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty