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NPI Code Detail

MEDICARE: EMBRACING AUTHENTICITY INC

MEDICARE: EMBRACING AUTHENTICITY INC
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
1261QM1300XMulti-Specialty Clinic/Center

General Provider Information

NPI Number : 1558129221
Entity Type Code : Organization
Provider Name (Legal Business Name) : EMBRACING AUTHENTICITY INC
Provider Business Mailing Address
First Line : 576 N 470 E
Second Line :
City : PROVIDENCE
State : UT
Zip : 84332-8901
Country : US
Telephone Number : 435-764-5186
Fax Number :
Provider Business Practice Location Address
First Line : 95 GOLF COURSE RD STE 105
Second Line :
City : LOGAN
State : UT
Zip : 84321-5990
Country : US
Telephone Number : 435-915-6398
Fax Number :
Authorized Official
Title or Position : PRESIDENT/CEO
Name : DR. CARLY D.L. LEBARON
Credential : PH.D., LMFT
Telephone Number : 435-915-6398
Provider Enumeration Date : 03/07/2024
Last Update Date : 03/07/2024

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Directions to “EMBRACING AUTHENTICITY INC ” Practice Location

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