Embodiment Therapy LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

EMBODIMENT THERAPY LLC

Practice address

63917 US Highway 93
Ronan, MT 59864-3411

Phone

(865) 368-5298

Fax

(406) 571-4008

NPI assigned

Nov 26, 2019

Last updated

Feb 24, 2022By 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

Jean Allison Church, LCSWNPI 1578063616

Title

Provider

Phone

(865) 368-5298

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Embodiment Therapy Other name

Medicare fee-for-service enrollment

Enrolled in MT

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jean Allison Church, LCSW

  • Clinical Social Worker
  • Ronan, MT
  • NPI 1578063616
  Medicare reassignment NPD Authorized official
• Shanley Swanson, MSW LAC

  • Clinical Social Worker
  • St Ignatius, MT
  • NPI 1326464397
  NPD

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

{
    "created_epoch": "1574726400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645660800000",
    "number": "1649816588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 423",
            "city": "RONAN",
            "state": "MT",
            "postal_code": "598640423",
            "telephone_number": "865-368-5298",
            "fax_number": "406-571-4008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "63917 US HIGHWAY 93",
            "city": "RONAN",
            "state": "MT",
            "postal_code": "598643411",
            "telephone_number": "865-368-5298",
            "fax_number": "406-571-4008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMBODIMENT THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-26",
        "last_updated": "2022-02-24",
        "certification_date": "2022-02-24",
        "status": "A",
        "authorized_official_last_name": "CHURCH",
        "authorized_official_first_name": "JEAN",
        "authorized_official_middle_name": "ALLISON",
        "authorized_official_title_or_position": "PROVIDER",
        "authorized_official_telephone_number": "865-368-5298",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1578063616",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Embodiment Therapy",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Matthew Delong, PLPC
• Krystal A Diel, LCSW
• Michael Dolecki, M.D.
• Jamie Duff, RPH
• Maria Elena Dumontier
• Rosemary Epperson, LMSW
• Angela Christine Evans, LAC
• Family Health Pharmacy
• Rebecca Filipowicz, PA-C, MS
• Kianna Finley, RN

• Clinical Social Worker in Ronan, MT
• Providers in Ronan, MT by specialty
• Clinical Social Worker in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.