MEDICARE: ELEVATE THERAPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1568069128
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELEVATE THERAPY

Provider Business Mailing Address
First Line	:	1564 N DAMEN AVE STE 208
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-2102
Country	:	US
Telephone Number	:	217-512-0346
Fax Number	:

Provider Business Practice Location Address
First Line	:	1564 N DAMEN AVE STE 208
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-2102
Country	:	US
Telephone Number	:	217-512-0346
Fax Number	:

Authorized Official
Title or Position	:	LICENSED THERAPIST/OWNER
Name	:	RALIAT Q ADEBOYEJO
Credential	:	LCPC
Telephone Number	:	217-512-0346

Provider Enumeration Date	:	10/07/2020
Last Update Date	:	01/03/2021

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Directions to “ELEVATE THERAPY ” Practice Location

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