Healthcare Provider Details

I. General information

NPI: 1235903071
Provider Name (Legal Business Name): ELEVATION BEHAVIORAL SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2023
Last Update Date: 11/16/2023
Certification Date: 11/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 W BLUE WATER EDGE DR
EUSTIS FL
32736-2255
US

IV. Provider business mailing address

18981 US HIGHWAY 441
MOUNT DORA FL
32757-6735
US

V. Phone/Fax

Practice location:
  • Phone: 321-278-7175
  • Fax:
Mailing address:
  • Phone: 321-278-7175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: ASHA M FURNESS
Title or Position: CEO
Credential: BCBA
Phone: 321-278-7175