Organization
EMBODIED CHANGE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MOLLIE RYAN LCPC (OWNER/PSYCHOTHERAPIST)
(773) 726-7290
Entity
Organization
Contact information
Practice address
2332 W FARWELL AVE APT 1E, CHICAGO, IL 60645-4753
(773) 726-7290
Mailing address
2332 W FARWELL AVE APT 1E, CHICAGO, IL 60645-4753
(773) 726-7290
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1316219892
—
IL
Enumeration date
10/25/2018
Last updated
12/17/2025
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