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General NPI Number Information
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NPI Number | 1386502920
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Entity Type | Organization
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Legal Business Name | EMBODIED PSYCHOTHERAPY, LLC
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Dates
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Enumeration Date | 01/13/2026
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Last Update Date | 01/13/2026
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Provider Practice Location Address
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Address Line | 1401 LAVACA ST # 308
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City | AUSTIN
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State | TX
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Zip | 78701-1634
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Country | US
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Telephone | 361-596-6424
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Fax |
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Provider Business Mailing Address
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Address Line | 1401 LAVACA ST # 308
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City | AUSTIN
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State | TX
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Zip | 78701-1634
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Country | US
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Telephone | 361-596-6424
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | VICTORIA LATIFSES
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Credential | PHD
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Telephone | 361-596-6424
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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