Healthcare Provider Details

I. General information

NPI: 1013730134
Provider Name (Legal Business Name): ELEVATE MENTAL HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2024
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3613 WILLIAMS DR STE 1004
GEORGETOWN TX
78628-1376
US

IV. Provider business mailing address

3613 WILLIAMS DR STE 1004
GEORGETOWN TX
78628-1376
US

V. Phone/Fax

Practice location:
  • Phone: 512-729-1800
  • Fax: 737-275-3466
Mailing address:
  • Phone: 512-585-8468
  • 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
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES PETTY
Title or Position: OWNERSHIP MEMBER
Credential:
Phone: 512-585-8468