MEDICARE: EMBRACING EMOTIONAL FREEDOM, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1033628474
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMBRACING EMOTIONAL FREEDOM, LLC

Provider Business Mailing Address
First Line	:	121 W 7500 S
Second Line	:
City	:	MIDVALE
State	:	UT
Zip	:	84047-2034
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2936 S HIGHLAND DR STE 100
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-3584
Country	:	US
Telephone Number	:	385-253-0888
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LAURA MOHLMAN
Credential	:	LCSW
Telephone Number	:	385-253-0888

Provider Enumeration Date	:	09/28/2017
Last Update Date	:	09/28/2017

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