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General NPI Number Information
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NPI Number | 1649163874
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Entity Type | Organization
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Legal Business Name | EMBERLY MENTAL HEALTH & WELLNESS
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Dates
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Enumeration Date | 05/28/2025
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Last Update Date | 11/04/2025
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Provider Practice Location Address
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Address Line | 12400 PORTLAND AVE STE 180
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City | BURNSVILLE
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State | MN
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Zip | 55337-6875
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Country | US
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Telephone | 651-689-3012
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Fax |
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Provider Business Mailing Address
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Address Line | 903 1ST ST N # 1047
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City | HOPKINS
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State | MN
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Zip | 55343-7526
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Country | US
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Telephone | 651-689-3012
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AMBER LAURA SCHUPP
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Credential | MA LPCC
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Telephone | 651-689-3012
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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 |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #3
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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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