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General NPI Number Information
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NPI Number | 1003780685
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Entity Type | Organization
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Legal Business Name | LIFE ELEVATED THERAPEUTIC SERVICES
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Dates
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Enumeration Date | 10/06/2025
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Last Update Date | 10/06/2025
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Provider Practice Location Address
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Address Line | 1500 N 19TH ST
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City | MONROE
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State | LA
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Zip | 71201-4942
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Country | US
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Telephone | 318-303-6618
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Fax |
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Provider Business Mailing Address
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Address Line | 1500 N 19TH ST
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City | MONROE
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State | LA
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Zip | 71201-4942
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Country | US
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Telephone | 318-303-6618
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | SIERRA ELLIS
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Credential | LCSW-BACS
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Telephone | 318-348-6493
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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