Healthcare Provider Details

I. General information

NPI: 1205749421
Provider Name (Legal Business Name): EMBER & RISE THERAPY GROUP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 MACOM DR STE 207
NAPERVILLE IL
60564-9361
US

IV. Provider business mailing address

2S345 ARROWHEAD DR
WHEATON IL
60189-1603
US

V. Phone/Fax

Practice location:
  • Phone: 630-256-8929
  • Fax:
Mailing address:
  • Phone: 630-202-7232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LAURA PROVANCAL
Title or Position: OWNER
Credential: LCSW
Phone: 630-202-7232