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NPI Code Detail

MEDICARE: EMBODY THERAPY LLC

MEDICARE: EMBODY THERAPY 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
11041C0700XClinical Social Worker
2101YM0800XMental Health Counselor

General Provider Information

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

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