Healthcare Provider Details

I. General information

NPI: 1083410021
Provider Name (Legal Business Name): ELEVATE CREATIVE PSYCHOTHERAPY AND MOVEMENT ARTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2025
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4009 FELLAND RD STE 105
MADISON WI
53718-6463
US

IV. Provider business mailing address

922 HAVEY RD
MADISON WI
53704-1354
US

V. Phone/Fax

Practice location:
  • Phone: 608-205-8302
  • Fax:
Mailing address:
  • Phone: 608-205-8302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAMIE L HAMELINK
Title or Position: OWNER
Credential:
Phone: 608-205-8302