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General NPI Number Information
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NPI Number | 1962371575
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Entity Type | Organization
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Legal Business Name | EMBODY THERAPY LLC
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Dates
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Enumeration Date | 11/03/2025
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Last Update Date | 01/28/2026
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Provider Practice Location Address
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Address Line | 6213 N GREEN BAY AVE
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City | GLENDALE
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State | WI
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Zip | 53209-3823
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Country | US
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Telephone | 414-235-7443
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Fax |
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Provider Business Mailing Address
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Address Line | 6213 N GREEN BAY AVE
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City | GLENDALE
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State | WI
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Zip | 53209-3823
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Country | US
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Telephone | 414-791-3130
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | ALEXANDRA DEVINE YARMULNIK
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Credential | LPC
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Telephone | 414-791-3130
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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 | 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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