Healthcare Provider Details

I. General information

NPI: 1326503053
Provider Name (Legal Business Name): ELEVATION BEHAVIORAL SCIENCE SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2019
Last Update Date: 12/03/2023
Certification Date: 12/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 CALLIE CT
NORTH SALT LAKE UT
84054-0165
US

IV. Provider business mailing address

919 CALLIE CT
NORTH SALT LAKE UT
84054-0165
US

V. Phone/Fax

Practice location:
  • Phone: 801-336-7406
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: DANIELLE MERRITT
Title or Position: OWNER
Credential: BCBA
Phone: 801-336-7406