Healthcare Provider Details

I. General information

NPI: 1164356515
Provider Name (Legal Business Name): EMBRACE WELLNESS BEHAVIORAL HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

187 STATE ST FL 4
PRESQUE ISLE ME
04769-2683
US

IV. Provider business mailing address

480 MAIN ST STE 1
PRESQUE ISLE ME
04769-2345
US

V. Phone/Fax

Practice location:
  • Phone: 207-380-4512
  • Fax:
Mailing address:
  • Phone: 207-380-4512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: MEGAN CLARK
Title or Position: OWNER
Credential:
Phone: 207-747-1644