Healthcare Provider Details

I. General information

NPI: 1174445183
Provider Name (Legal Business Name): ELEVATE TO NEW BEGINNINGS COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19060 EVERETT BLVD UNIT 204
MOKENA IL
60448-2501
US

IV. Provider business mailing address

6423 MONDA AVE
PORTAGE IN
46368-4546
US

V. Phone/Fax

Practice location:
  • Phone: 815-405-8197
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: THERESA WORKMAN
Title or Position: OWNER/MANGER
Credential: LCSW
Phone: 815-405-8197