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General NPI Number Information
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NPI Number | 1730656000
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Entity Type | Organization
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Legal Business Name | EMBODIED CHANGE, INC
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Dates
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Enumeration Date | 10/25/2018
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Last Update Date | 12/17/2025
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Provider Practice Location Address
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Address Line | 2332 W FARWELL AVE APT 1E
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City | CHICAGO
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State | IL
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Zip | 60645-4753
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Country | US
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Telephone | 773-726-7290
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Fax |
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Provider Business Mailing Address
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Address Line | 2332 W FARWELL AVE APT 1E
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City | CHICAGO
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State | IL
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Zip | 60645-4753
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Country | US
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Telephone | 773-726-7290
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Fax |
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Authorized Official
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Title or Position | OWNER/PSYCHOTHERAPIST
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Name | MOLLIE RYAN
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Credential | LCPC
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Telephone | 773-726-7290
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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