Provider Demographics
NPI:1962287250
Name:EMBODIED CONNECTIONS THERAPY LLC
Entity type:Organization
Organization Name:EMBODIED CONNECTIONS THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EVA
Authorized Official - Middle Name:CHESLER
Authorized Official - Last Name:FIRTH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-244-0211
Mailing Address - Street 1:18650 SW BOONES FERRY RD STE 3
Mailing Address - Street 2:
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-8491
Mailing Address - Country:US
Mailing Address - Phone:801-244-0211
Mailing Address - Fax:
Practice Address - Street 1:21427 SW 90TH CT
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-8909
Practice Address - Country:US
Practice Address - Phone:801-244-0211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-28
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty