Provider Demographics
NPI:1740644590
Name:EMBARK COUNSELING LLC
Entity type:Organization
Organization Name:EMBARK COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DESALVO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-726-4560
Mailing Address - Street 1:8191 SOUTHPARK LN
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-4638
Mailing Address - Country:US
Mailing Address - Phone:303-726-4560
Mailing Address - Fax:
Practice Address - Street 1:8191 SOUTHPARK LN
Practice Address - Street 2:SUITE 201
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-4638
Practice Address - Country:US
Practice Address - Phone:303-726-4560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-07
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONLC.0008685101YM0800X
COLPC4585101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty