MEDICARE: EMBODIMENT COUNSELING 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194473082
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMBODIMENT COUNSELING LLC

Provider Business Mailing Address
First Line	:	7820 ENCHANTED HILLS BLVD NE STE A177
Second Line	:
City	:	RIO RANCHO
State	:	NM
Zip	:	87144-8638
Country	:	US
Telephone Number	:	505-372-4918
Fax Number	:

Provider Business Practice Location Address
First Line	:	7820 ENCHANTED HILLS BLVD NE STE A177
Second Line	:
City	:	RIO RANCHO
State	:	NM
Zip	:	87144-8638
Country	:	US
Telephone Number	:	505-929-9224
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST
Name	:	IRMA JESSICA SALGADO
Credential	:	LCSW
Telephone Number	:	505-372-4918

Provider Enumeration Date	:	03/10/2022
Last Update Date	:	02/06/2026

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