Healthcare Provider Details

I. General information

NPI: 1962371575
Provider Name (Legal Business Name): EMBODY THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2025
Last Update Date: 01/28/2026
Certification Date: 01/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6213 N GREEN BAY AVE
GLENDALE WI
53209-3823
US

IV. Provider business mailing address

6213 N GREEN BAY AVE
GLENDALE WI
53209-3823
US

V. Phone/Fax

Practice location:
  • Phone: 414-235-7443
  • Fax:
Mailing address:
  • Phone: 414-791-3130
  • 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

VIII. Authorized Official

Name: ALEXANDRA DEVINE YARMULNIK
Title or Position: OWNER/THERAPIST
Credential: LPC
Phone: 414-791-3130