EMBODIED LIFE THERAPY CENTER LLC (NPI# 1265039564) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1265039564 |
| Entity Type | Organization |
| Organization Name | EMBODIED LIFE THERAPY CENTER LLC |
| Practice Address |
6906 N Richards St Portland OR 97203-6138 |
| Practice Telephone | 9713360338 |
| Mailing Telephone | 9713360338 |
| Enumeration Date | 2020-10-08 |
| Last Update Date | 2020-10-08 |
| Authorized Official Name | JENNIFER DODD (OWNER) |
| Authorized Official Telephone | 9712661081 |
| Authorized Official Credential | LCSW |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM0850X |
Clinic/Center Specialization: Adult Mental Health |
Ambulatory Health Care Facilities |
| Street Address |
6906 N RICHARDS ST |
| City | PORTLAND |
| State | OR |
| Zip Code | 97203-6138 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952923757 | Justin Cummings | Meals | 10105 N. Oswego Ave, Portland, OR 97203 | 2020-05-14 |
| 1407335045 | Gage Solis | Student in an Organized Health Care Education/Training Program | 8425 N. Lombard St, Portland, OR 97203 | 2018-08-13 |
| 1497103493 | Ruby Diane Ciarlante | Community Health Worker | 7803 N Portsmouth Ave, Portland, OR 97203 | 2016-05-31 |
| 1992139620 | Hannah Clare | Speech-Language Pathologist | 7126 N Amherst St, Portland, OR 97203 | 2013-08-29 |
| 1043656713 | Heather Ranae Mcintosh | Social Worker | 7323 N Burlington Ave, Portland, OR 97203 | 2013-05-21 |
| 1275879363 | Matthew Scott Bennett | Pharmacist | 6850 N. Lombard, Portland, OR 97203 | 2012-12-18 |
| 1144594094 | Candice Juliet Thomas | Pharmacist | 9000 N. Lombard St, Portland, OR 97203 | 2012-02-23 |
| 1093013211 | Aarisa Elysianne Smith | Mechanotherapist | 8438 N Lombard St, Ste 7, Portland, OR 97203 | 2011-03-11 |
| 1700103546 | Lisa Catherine Davis | Acupuncturist | 1614 Ne Alberta Street, Portland, OR 97203 | 2010-05-03 |
| 1427298579 | Donald Marvin Lorenzen | Denturist | 8530 N. Ivanhoe, Portland, OR 97203 | 2009-03-03 |
| Find all providers in zip 97203 | ||||
| Taxonomy Code | 261QM0850X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Adult Mental Health |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851999841 | Laura Gottfried Lcsw Inc. | Clinic/Center | 145 Newbury St Ste 2, Portland, ME 04101-4261 | 2020-10-13 |
| 1720685696 | Pragmatic Healing LLC | Clinic/Center | 3930 Sw Plum St Apt 1, Portland, OR 97219-6046 | 2020-10-05 |
| 1467086215 | Deborah Ann Jewell | Clinic/Center | 5627 Ne Simpson St, Portland, OR 97218-2329 | 2020-03-01 |
| 1174023808 | Blake Locher Counseling, LLC | Clinic/Center | 1020 Sw Taylor St Ste 449, Portland, OR 97205-2556 | 2018-02-19 |
| 1134633100 | Paul Myers, Ph.d., LLC | Clinic/Center | 5441 Sw Macadam Ave Ste 104, Portland, OR 97239-3821 | 2017-11-28 |
| 1891206785 | Janz Consulting | Clinic/Center | 1020 Sw Taylor St Ste 635, Portland, OR 97205-2524 | 2017-10-18 |
| 1467979914 | Awakened Heart Pdx, LLC | Clinic/Center | 322 Nw 5th Ave Ste 308, Portland, OR 97209-3851 | 2017-08-25 |
| 1669739389 | Casco Bay Medical Pllc | Clinic/Center | 371 Fore St, 201, Portland, ME 04101-5112 | 2012-04-19 |
| 1306132220 | Patricia Camplair, Phd PC | Clinic/Center | 1020 Sw Taylor St Ste 720, Portland, OR 97205-2512 | 2011-06-20 |
| 1124310305 | Telecare Mental Health Services of Oregon, Inc. | Clinic/Center | 30 Ne Martin Luther King Blvd, Portland, OR 97232-2941 | 2011-05-06 |
| Find all providers in PORTLAND | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.