Healthcare Provider Details

I. General information

NPI: 1396674214
Provider Name (Legal Business Name): ELEVATE MIND & BODY WELLNESS CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2026
Last Update Date: 05/16/2026
Certification Date: 05/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 SOUTHWICK DR STE 630-H
MATTESON IL
60443-2254
US

IV. Provider business mailing address

4801 SOUTHWICK DR STE 630-H
MATTESON IL
60443-2254
US

V. Phone/Fax

Practice location:
  • Phone: 708-793-3430
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: KARA TALIAFERRO
Title or Position: OWNER
Credential: NP
Phone: 708-269-3121