Healthcare Provider Details

I. General information

NPI: 1750250742
Provider Name (Legal Business Name): ELEVATE360 SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2025
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10707 CORPORATE DR STE 250
STAFFORD TX
77477-4037
US

IV. Provider business mailing address

3627 CIBOLO CT
PEARLAND TX
77584-3975
US

V. Phone/Fax

Practice location:
  • Phone: 678-677-4041
  • Fax:
Mailing address:
  • Phone: 678-677-4041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: TYRONE LANE
Title or Position: EXECUTIVE DIRECTOR
Credential: MA,
Phone: 678-677-4041