MEDICARE: ELEVATE PSYCHOLOGY PLLC

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	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1952906687
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELEVATE PSYCHOLOGY PLLC

Provider Business Mailing Address
First Line	:	4810 POINT FOSDICK DR #163
Second Line	:
City	:	GIG HARBOR
State	:	WA
Zip	:	98335-1711
Country	:	US
Telephone Number	:	253-265-5584
Fax Number	:

Provider Business Practice Location Address
First Line	:	4810 POINT FOSDICK DR #163
Second Line	:
City	:	GIG HARBOR
State	:	WA
Zip	:	98335-1711
Country	:	US
Telephone Number	:	253-265-5584
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL PSYCHOLOGIST
Name	:	DR. JESSICA CARLILE
Credential	:	PH.D.
Telephone Number	:	206-590-4094

Provider Enumeration Date	:	12/01/2020
Last Update Date	:	12/04/2020

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