Healthcare Provider Details

I. General information

NPI: 1700730124
Provider Name (Legal Business Name): EMBERLIGHT THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2026
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

775 BELMONT CT
ANTIOCH IL
60002-1119
US

IV. Provider business mailing address

775 BELMONT CT
ANTIOCH IL
60002-1119
US

V. Phone/Fax

Practice location:
  • Phone: 847-528-1885
  • Fax:
Mailing address:
  • Phone: 847-528-1885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: KATIE HOLLEY
Title or Position: OWNER, THERAPIST
Credential: LPC
Phone: 847-528-1885