Healthcare Provider Details

I. General information

NPI: 1124518709
Provider Name (Legal Business Name): EMBARK COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2018
Last Update Date: 05/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1969 E 68TH ST
COLUMBUS NE
68601-9618
US

IV. Provider business mailing address

1969 E 68TH ST
COLUMBUS NE
68601-9618
US

V. Phone/Fax

Practice location:
  • Phone: 402-276-1502
  • Fax:
Mailing address:
  • Phone: 402-276-1502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1759
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number183
License Number StateNE

VIII. Authorized Official

Name: MINDY MUHLE
Title or Position: OWNER
Credential: LIMHP, LMFT, MEDFT
Phone: 402-276-1502