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NPI Code Detail

MEDICARE: ELEVATE PSYCHOLOGY, LLC

MEDICARE: ELEVATE PSYCHOLOGY, LLC
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
1103TC0700XClinical Psychologist

General Provider Information

NPI Number : 1710708144
Entity Type Code : Organization
Provider Name (Legal Business Name) : ELEVATE PSYCHOLOGY, LLC
Provider Business Mailing Address
First Line : 16220 N SCOTTSDALE RD STE 300
Second Line :
City : SCOTTSDALE
State : AZ
Zip : 85254-1798
Country : US
Telephone Number : 480-328-8464
Fax Number :
Provider Business Practice Location Address
First Line : 16220 N SCOTTSDALE RD STE 300
Second Line :
City : SCOTTSDALE
State : AZ
Zip : 85254-1798
Country : US
Telephone Number : 480-328-8464
Fax Number :
Authorized Official
Title or Position : PSYCHOLOGIST/OWNER
Name : DR. DIANA MEDINA
Credential : PHD
Telephone Number : 480-328-8464
Provider Enumeration Date : 10/18/2024
Last Update Date : 10/18/2024

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