Healthcare Provider Details

I. General information

NPI: 1700498763
Provider Name (Legal Business Name): ELEVATED GROUPS COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2020
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10436 SOUTHWEST HWY STE 5
CHICAGO RIDGE IL
60415-2284
US

IV. Provider business mailing address

10436 SOUTHWEST HWY
CHICAGO RIDGE IL
60415-2282
US

V. Phone/Fax

Practice location:
  • Phone: 708-671-8244
  • Fax: 708-377-3960
Mailing address:
  • Phone: 708-444-0304
  • Fax: 708-377-3960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MOHAMMED TARAWNEH
Title or Position: CEO
Credential: CADC
Phone: 708-444-0304