NPIMap

Organization Active NPI

Emberlight Therapy LLC

  • Clinical Social Worker
  • Mendota Heights, MN
National Provider Identifier
1538038468
Registry record updated Oct 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
EMBERLIGHT THERAPY LLC
Practice address
2575 Heritage Dr
Mendota Heights, MN 55120-1737
Phone
(612) 608-9068
NPI assigned
Oct 30, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2025

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

Authorized official

Name
Nicole Davis, LICSWNPI 1457846313
Title
Owner
Phone
(612) 608-9068

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X Primary

Addresses

Primary practice location

2575 Heritage Dr
Mendota Heights, MN 55120-1737

Mailing address

2575 Heritage Dr
Mendota Heights, MN 55120-1737
Phone (612) 608-9068

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1761782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1761782400000",
    "number": "1538038468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2575 HERITAGE DR",
            "city": "MENDOTA HEIGHTS",
            "state": "MN",
            "postal_code": "551201737",
            "telephone_number": "612-608-9068"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2575 HERITAGE DR",
            "city": "MENDOTA HEIGHTS",
            "state": "MN",
            "postal_code": "551201737",
            "telephone_number": "612-608-9068"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMBERLIGHT THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-10-30",
        "last_updated": "2025-10-30",
        "certification_date": "2025-10-30",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "612-608-9068",
        "authorized_official_credential": "LICSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mendota Heights, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2025; 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.