Healthcare Provider Details

I. General information

NPI: 1114872181
Provider Name (Legal Business Name): EMBERSTONE THERAPY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2026
Last Update Date: 03/08/2026
Certification Date: 03/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

936 IDA ST
POPLAR BLUFF MO
63901-4210
US

IV. Provider business mailing address

936 IDA ST
POPLAR BLUFF MO
63901-4210
US

V. Phone/Fax

Practice location:
  • Phone: 573-429-4846
  • Fax:
Mailing address:
  • Phone: 573-429-4846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LORI LADY
Title or Position: OWNER
Credential: LCSW
Phone: 573-429-4846