Embodied Ecology Group

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

80304 Issued in CA

Legal business name

EMBODIED ECOLOGY GROUP

Doing business as

Santa Cruz Neurofeedback Center
The Center

Practice address

2425 Porter St Ste 7
Soquel, CA 95073-2454

Phone

(831) 464-1419

Fax

(831) 476-7529

NPI assigned

May 11, 2017

Last updated

Dec 11, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Langdon SE Roberts

Title

Ceo

Phone

(831) 239-6353

Specialties & licenses 4

Addresses

Other names 2

• Santa Cruz Neurofeedback Center Doing business as
• The Center Doing business as

Locations

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

{
    "created_epoch": "1494460800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607644800000",
    "number": "1346776226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2425 PORTER ST STE 7",
            "city": "SOQUEL",
            "state": "CA",
            "postal_code": "950732454",
            "telephone_number": "831-464-1419",
            "fax_number": "831-476-7529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2425 PORTER ST STE 7",
            "city": "SOQUEL",
            "state": "CA",
            "postal_code": "950732454",
            "telephone_number": "831-464-1419",
            "fax_number": "831-476-7529"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMBODIED ECOLOGY GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-11",
        "last_updated": "2020-12-11",
        "certification_date": "2020-12-11",
        "status": "A",
        "authorized_official_last_name": "ROBERTS",
        "authorized_official_first_name": "LANGDON",
        "authorized_official_middle_name": "SE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "831-239-6353"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "80304",
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "174H00000X",
            "taxonomy_group": "",
            "desc": "Health Educator",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "172M00000X",
            "taxonomy_group": "",
            "desc": "Mechanotherapist",
            "state": "CA",
            "license": "50028",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Santa Cruz Neurofeedback Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Daniel Alan Droke, MA, LMFT
• Victoria Eagle
• Melissa Anne Edwards, MSW, LCSW114031
• Charles David Eldridge III, M.D.
• Leah Louanne Ellison Cole, PH D
• Eric R. Carlblom, MD.,PC
• Emily Louise Erickson
• Excel Performance Physical Therapy, P.C.
• Marilyn Fahrner, MFT
• Elizabeth Anne Falade, MD, MPH

• Marriage & Family Therapist in Soquel, CA
• Providers in Soquel, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2020; 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.