Healthcare Provider Details

I. General information

NPI: 1164386850
Provider Name (Legal Business Name): ELEVATE LIFE COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

121 MOCKINGBIRD HILL DR
RICHMOND KY
40475-8007
US

IV. Provider business mailing address

121 MOCKINGBIRD HILL DR
RICHMOND KY
40475-8007
US

V. Phone/Fax

Practice location:
  • Phone: 859-222-6282
  • Fax:
Mailing address:
  • Phone: 859-222-6282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: RICHARD L WHEELER
Title or Position: OWNER
Credential: LPCC
Phone: 859-222-6282