Healthcare Provider Details

I. General information

NPI: 1619465838
Provider Name (Legal Business Name): ELEVATE COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2018
Last Update Date: 04/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 5TH ST STE 8
RAWLINS WY
82301-5632
US

IV. Provider business mailing address

PO BOX 1589
RAWLINS WY
82301-1589
US

V. Phone/Fax

Practice location:
  • Phone: 307-320-3082
  • Fax:
Mailing address:
  • Phone: 307-320-3082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberLCSW-1028
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MS. KAREN K ELLIS
Title or Position: CLINICAL SOCIAL WORKER
Credential: LCSW
Phone: 307-320-3082