Embodied Life Therapy Center LLC
Clinic/Center (Adult Mental Health)

Address: 6906 N Richards St, Portland, OR 97203-6138
Phone: 9713360338

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).

Provider Overview

Nation Provider Identifier (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 Address 6906 N Richards St
Portland
OR 97203-6138
Mailing Telephone 9713360338
Authorized Official Name Jennifer Dodd (OWNER)
Authorized Official Telephone 9712661081
Authorized Official Credential LCSW
Organization Subpart No, this organization is not a Subpart
Enumeration Date 2020-10-08
Last Update Date 2020-10-08

Taxonomy Codes

Primary Taxonomy Classification Taxonomy Group License Number State
Yes 261QM0850X Clinic/Center · Adult Mental Health Ambulatory Health Care Facilities

Taxonomy Information

Taxonomy Code 261QM0850X
Grouping Ambulatory Health Care Facilities
Classification Clinic/Center
Specialization Adult Mental Health

Taxonomy Definition

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]

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Office Location

Street Address 6906 N RICHARDS ST
City PORTLAND
State OR
Zip Code 97203-6138

Providers in the same zip code

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
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Competitor

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City PORTLAND
Zip Code 97203

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Dataset Information

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.