Provider Demographics
NPI:1013734714
Name:EMBODIED MENTAL HEALTH COUNSELING LLC
Entity type:Organization
Organization Name:EMBODIED MENTAL HEALTH COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHELBY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:260-440-1001
Mailing Address - Street 1:127 W BERRY ST STE 311
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46802-2310
Mailing Address - Country:US
Mailing Address - Phone:260-440-1001
Mailing Address - Fax:
Practice Address - Street 1:127 W BERRY ST STE 311
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46802-2310
Practice Address - Country:US
Practice Address - Phone:260-440-1001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)