Healthcare Provider Details

I. General information

NPI: 1326968512
Provider Name (Legal Business Name): EMBARK BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 E HAMILTON AVE STE 110
CAMPBELL CA
95008-0612
US

IV. Provider business mailing address

926 S FREMONT ST UNIT B
SAN MATEO CA
94402-1812
US

V. Phone/Fax

Practice location:
  • Phone: 408-351-0382
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH EVANS
Title or Position: THERAPIST
Credential: ASW
Phone: 480-795-3888