Provider Demographics
NPI:1740093129
Name:EMBRACING INNER PEACE, P-LLC
Entity type:Organization
Organization Name:EMBRACING INNER PEACE, P-LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:217-416-0641
Mailing Address - Street 1:25870 HETTICK SCOTTVILLE RD
Mailing Address - Street 2:
Mailing Address - City:HETTICK
Mailing Address - State:IL
Mailing Address - Zip Code:62649-4791
Mailing Address - Country:US
Mailing Address - Phone:217-416-0641
Mailing Address - Fax:
Practice Address - Street 1:25870 HETTICK SCOTTVILLE RD
Practice Address - Street 2:
Practice Address - City:HETTICK
Practice Address - State:IL
Practice Address - Zip Code:62649-4791
Practice Address - Country:US
Practice Address - Phone:217-416-0641
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty