Healthcare Provider Details

I. General information

NPI: 1972366334
Provider Name (Legal Business Name): ELEVATION PSYCHOLOGICAL SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2024
Last Update Date: 05/04/2025
Certification Date: 05/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2607 BRIDGEPORT WAY W STE 2D
UNIVERSITY PLACE WA
98466-4725
US

IV. Provider business mailing address

2607 BRIDGEPORT WAY W STE 2D
UNIVERSITY PLACE WA
98466-4725
US

V. Phone/Fax

Practice location:
  • Phone: 253-446-2319
  • Fax: 253-375-1653
Mailing address:
  • Phone: 253-486-7735
  • Fax: 253-375-1653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RAY JASON KATZENBACH
Title or Position: MEMBER
Credential: PH.D.
Phone: 253-486-7735