| Embodiment Therapy | |
|
63917 Us Highway 93 Ronan MT 59864-3411 | |
| (865) 368-5298 | |
| (406) 571-4008 |
| Full Name | Embodiment Therapy |
|---|---|
| Speciality | Social Worker |
| Location | 63917 Us Highway 93, Ronan, Montana |
| Authorized Official Name and Position | Jean Allison Church (PROVIDER) |
| Authorized Official Contact | 8653685298 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Embodiment Therapy Po Box 423 Ronan MT 59864-0423 Ph: (865) 368-5298 | Embodiment Therapy 63917 Us Highway 93 Ronan MT 59864-3411 Ph: (865) 368-5298 |
| NPI Number | 1649816588 |
|---|---|
| Provider Enumeration Date | 11/26/2019 |
| Last Update Date | 02/24/2022 |
| Certification Date | 02/24/2022 |
| Medicare PECOS PAC ID | 0941694566 |
|---|---|
| Medicare Enrollment ID | O20220224002514 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649816588 | NPI | - | NPPES |
| 1578063616 | Medicaid | MT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Jean Allison Church |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1578063616 PECOS PAC ID: 2769876382 Enrollment ID: I20220224002564 |
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