Healthcare Provider Details

I. General information

NPI: 1235882879
Provider Name (Legal Business Name): EMBODIED WAY PSYCHOTHERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2022
Last Update Date: 02/03/2022
Certification Date: 02/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 W NORWOOD ST APT 3
CHICAGO IL
60660-2592
US

IV. Provider business mailing address

1215 W NORWOOD ST APT 3
CHICAGO IL
60660-2592
US

V. Phone/Fax

Practice location:
  • Phone: 312-608-2999
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225600000X
TaxonomyDance Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. CHIH-HSIEN LIN
Title or Position: FOUNDER
Credential: LCPC, BC-DMT
Phone: 773-234-9115