MEDICARE: ELEVATION WELLNESS CENTER LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	101YP2500X	Professional Counselor
3	1041C0700X	Clinical Social Worker
4	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
5	261QM0850X	Adult Mental Health Clinic/Center
6	261QM0855X	Adolescent and Children Mental Health Clinic/Center
7	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1770302663
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELEVATION WELLNESS CENTER LLC

Provider Business Mailing Address
First Line	:	PO BOX 868
Second Line	:
City	:	RIVERTON
State	:	WY
Zip	:	82501-0116
Country	:	US
Telephone Number	:	307-840-3594
Fax Number	:

Provider Business Practice Location Address
First Line	:	902 N 8TH ST W
Second Line	:
City	:	RIVERTON
State	:	WY
Zip	:	82501-2332
Country	:	US
Telephone Number	:	307-840-3594
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	STEPHANIE PETERSON
Credential	:
Telephone Number	:	307-840-3594

Provider Enumeration Date	:	10/08/2024
Last Update Date	:	02/03/2025

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