# EMBODIMENT THERAPY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Embodiment Therapy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1649816588
- **Authorized official:** JEAN ALLISON CHURCH LCSW (PROVIDER)
- **Authorized official phone:** (865) 368-5298

## Contact information

- **Practice address:** 63917 US HIGHWAY 93, RONAN, MT 59864-3411
- **Practice address phone:** (865) 368-5298
- **Practice address fax:** (406) 571-4008
- **Mailing address:** PO BOX 423, RONAN, MT 59864-0423
- **Mailing address phone:** (865) 368-5298
- **Mailing address fax:** (406) 571-4008

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | — | NULL | Yes |
| 1041C0700X | Clinical Social Worker | — | — | Yes |

## Other

- **Enumeration date:** 11/26/2019
- **Last updated:** 02/24/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1578063616 | — | MT |