Organization
EMBERLIGHT THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE DAVIS LICSW (OWNER)
(612) 608-9068
Entity
Organization
Contact information
Practice address
2575 HERITAGE DR, MENDOTA HEIGHTS, MN 55120-1737
(612) 608-9068
Mailing address
2575 HERITAGE DR, MENDOTA HEIGHTS, MN 55120-1737
(612) 608-9068
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
10/30/2025
Last updated
10/30/2025
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