Healthcare Provider Details

I. General information

NPI: 1437053188
Provider Name (Legal Business Name): EMBOLDEN BEHAVIORAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

2060 E PLANK RD UNIT 3
APPLETON WI
54915-7045
US

IV. Provider business mailing address

2060 E PLANK RD UNIT 3
APPLETON WI
54915-7045
US

V. Phone/Fax

Practice location:
  • Phone: 715-347-3046
  • Fax: 833-548-1003
Mailing address:
  • Phone: 715-347-3046
  • Fax: 833-548-1003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name: BRENNA CARLSON
Title or Position: OWNER
Credential: BCBA
Phone: 715-347-3046