MEDICARE: EMBRACE COUNSELING CENTER, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	261QM0850X	Adult Mental Health Clinic/Center
3	261QM0855X	Adolescent and Children Mental Health Clinic/Center
4	101Y00000X	Counselor

General Provider Information

NPI Number	:	1922873546
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMBRACE COUNSELING CENTER, LLC

Provider Business Mailing Address
First Line	:	4905 POPLAR SPRINGS DR STE B
Second Line	:
City	:	MERIDIAN
State	:	MS
Zip	:	39305-1642
Country	:	US
Telephone Number	:	601-453-2824
Fax Number	:	601-453-2787

Provider Business Practice Location Address
First Line	:	4905 POPLAR SPRINGS DR STE B
Second Line	:
City	:	MERIDIAN
State	:	MS
Zip	:	39305-1642
Country	:	US
Telephone Number	:	601-453-2824
Fax Number	:	601-453-2787

Authorized Official
Title or Position	:	OWNER
Name	:	HUNTER BURNS
Credential	:	MS, LPC, NCC, BC-TMH
Telephone Number	:	601-480-8836

Provider Enumeration Date	:	11/24/2023
Last Update Date	:	11/24/2023

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