Healthcare Provider Details

I. General information

NPI: 1831012962
Provider Name (Legal Business Name): EMBODIED COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 TECHNOLOGY DR NE STE 110
WILLMAR MN
56201-2283
US

IV. Provider business mailing address

1700 TECHNOLOGY DR NE STE 110
WILLMAR MN
56201-2283
US

V. Phone/Fax

Practice location:
  • Phone: 320-212-7419
  • Fax:
Mailing address:
  • Phone: 320-212-7419
  • 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: KAHLE RANDALL
Title or Position: OWNER
Credential: MA, LPCC, CIEC, CCTP
Phone: 320-212-7419