Basic Information
| Provider Information | |||||||||
| NPI: | 1003587213 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ELEVATE THERAPY LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 170 SOUTH 2ND STREET | ||||||||
| Address2: | SUITE C | ||||||||
| City: | HAMILTON | ||||||||
| State: | MT | ||||||||
| PostalCode: | 598402561 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 170 SOUTH 2ND STREET | ||||||||
| Address2: | SUITE C | ||||||||
| City: | HAMILTON | ||||||||
| State: | MT | ||||||||
| PostalCode: | 598402561 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4063812592 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2021 | ||||||||
| LastUpdateDate: | 09/27/2021 | ||||||||
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| AuthorizedOfficialLastName: | CASHELL | ||||||||
| AuthorizedOfficialFirstName: | HEATHER | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4063812592 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
| NPICertificationDate: | 09/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.