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General NPI Number Information
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NPI Number | 1548872211
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Entity Type | Organization
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Legal Business Name | EMBARK COUNSELING & COACHING LLC
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Dates
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Enumeration Date | 08/23/2020
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Last Update Date | 08/31/2020
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Provider Practice Location Address
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Address Line | 640 GRAND AVE
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City | GRAND JUNCTION
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State | CO
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Zip | 81501-2738
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Country | US
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Telephone | 970-549-0183
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Fax |
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Provider Business Mailing Address
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Address Line | 414 EAGLE CREST CT
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City | GRAND JUNCTION
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State | CO
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Zip | 81507-3307
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Country | US
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Telephone | 480-343-4919
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MATTHEW ANGLEMAN
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Credential | MA, LPC
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Telephone | 480-343-4919
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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