Healthcare Provider Details

I. General information

NPI: 1780310276
Provider Name (Legal Business Name): ELEVATION GAIN COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2022
Last Update Date: 07/27/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

897 RIM ROCK RD
BAILEY CO
80421-2142
US

IV. Provider business mailing address

897 RIM ROCK RD
BAILEY CO
80421-2142
US

V. Phone/Fax

Practice location:
  • Phone: 720-383-3298
  • Fax:
Mailing address:
  • Phone: 720-383-3298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. TAEGAN DOLPHIN
Title or Position: PSYCHOTHERAPIST
Credential: LCSW
Phone: 720-383-3298