=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427915693
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EMBODY WELLNESS, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/08/2026
-----------------------------------------------------
Last Update Date | 01/08/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2794 SOUTH GOLIAD STREET
-----------------------------------------------------
City | ROCKWALL
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75087
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-269-5324
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2703 VZ COUNTY ROAD 4414
-----------------------------------------------------
City | CANTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75103-5984
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-269-4325
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DARA HENDON
-----------------------------------------------------
Credential | LCSW-S
-----------------------------------------------------
Telephone | 469-269-5324
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------