Healthcare Provider Details

I. General information

NPI: 1225992506
Provider Name (Legal Business Name): EMBODIED ESSENCE THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 S BROADWAY STE 231
CORTEZ CO
81321-4033
US

IV. Provider business mailing address

925 S BROADWAY STE 231
CORTEZ CO
81321-4033
US

V. Phone/Fax

Practice location:
  • Phone: 505-609-8519
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: SHANELL ALLEVA
Title or Position: OWNER/CLINICIAN
Credential: LCSW
Phone: 505-609-8519