Healthcare Provider Details

I. General information

NPI: 1861328098
Provider Name (Legal Business Name): ELEV8 WELLNESS AZ, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 N MESA DR STE 115
MESA AZ
85201-5974
US

IV. Provider business mailing address

460 N MESA DR
MESA AZ
85201-5973
US

V. Phone/Fax

Practice location:
  • Phone: 480-214-3120
  • Fax: 480-999-5541
Mailing address:
  • Phone: 480-214-3120
  • Fax: 480-999-5541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. KATRINA ANN GARY
Title or Position: FICILITY MANAGER
Credential:
Phone: 480-214-3120