Healthcare Provider Details

I. General information

NPI: 1649163874
Provider Name (Legal Business Name): EMBERLY MENTAL HEALTH & WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2025
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10800 LYNDALE AVE S STE 350
BLOOMINGTON MN
55420-5648
US

IV. Provider business mailing address

903 1ST ST N # 1047
HOPKINS MN
55343-7526
US

V. Phone/Fax

Practice location:
  • Phone: 651-689-3012
  • Fax:
Mailing address:
  • Phone: 651-689-3012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: AMBER LAURA SCHUPP
Title or Position: OWNER
Credential: MA LPCC
Phone: 651-689-3012