Embodied Therapy Services, LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

EMBODIED THERAPY SERVICES, LLC

Practice address

806 Pavilion CT
McDonough, GA 30253-6666

Phone

(404) 805-1828

Fax

(678) 466-7561

NPI assigned

Mar 11, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jaquita ShortsNPI 1518322395

Title

Owner

Phone

(404) 805-1828

Specialties & licenses 2

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jaquita Shorts

  • Professional Counselor
  • McDonough, GA
  • NPI 1518322395
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1710115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710115200000",
    "number": "1205694544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "806 PAVILION CT",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302536666",
            "telephone_number": "404-805-1828",
            "fax_number": "678-466-7561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "806 PAVILION CT",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302536666",
            "telephone_number": "404-805-1828",
            "fax_number": "678-466-7561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMBODIED THERAPY SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-11",
        "last_updated": "2024-03-11",
        "certification_date": "2024-03-11",
        "status": "A",
        "authorized_official_last_name": "SHORTS",
        "authorized_official_first_name": "JAQUITA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "404-805-1828"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.