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General NPI Number Information
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NPI Number | 1205749421
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Entity Type | Organization
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Legal Business Name | EMBER & RISE THERAPY GROUP, PLLC
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Dates
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Enumeration Date | 09/28/2026
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Last Update Date | 09/28/2026
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Provider Practice Location Address
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Address Line | 1315 MACOM DR STE 207
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City | NAPERVILLE
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State | IL
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Zip | 60564-9361
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Country | US
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Telephone | 630-256-8929
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Fax |
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Provider Business Mailing Address
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Address Line | 2S345 ARROWHEAD DR
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City | WHEATON
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State | IL
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Zip | 60189-1603
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Country | US
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Telephone | 630-202-7232
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LAURA PROVANCAL
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Credential | LCSW
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Telephone | 630-202-7232
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State | NULL
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