MEDICARE: EMBERSTONE THERAPY SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1114872181
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMBERSTONE THERAPY SERVICES, LLC

Provider Business Mailing Address
First Line	:	936 IDA ST
Second Line	:
City	:	POPLAR BLUFF
State	:	MO
Zip	:	63901-4210
Country	:	US
Telephone Number	:	573-429-4846
Fax Number	:

Provider Business Practice Location Address
First Line	:	936 IDA ST
Second Line	:
City	:	POPLAR BLUFF
State	:	MO
Zip	:	63901-4210
Country	:	US
Telephone Number	:	573-429-4846
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LORI LADY
Credential	:	LCSW
Telephone Number	:	573-429-4846

Provider Enumeration Date	:	03/03/2026
Last Update Date	:	03/08/2026

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