Organization
EMBODIMENT THERAPY LLC
Active
Other names
Embodiment Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
JEAN ALLISON CHURCH LCSW (PROVIDER)
(865) 368-5298
Entity
Organization
Contact information
Practice address
63917 US HIGHWAY 93, RONAN, MT 59864-3411
(865) 368-5298
(406) 571-4008
Mailing address
PO BOX 423, RONAN, MT 59864-0423
(865) 368-5298
(406) 571-4008
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1578063616
—
MT
Enumeration date
11/26/2019
Last updated
02/24/2022
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