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General NPI Number Information
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NPI Number | 1013730134
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Entity Type | Organization
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Legal Business Name | ELEVATE METAL HEALTH PLLC
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Dates
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Enumeration Date | 11/06/2024
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Last Update Date | 01/29/2025
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Provider Practice Location Address
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Address Line | 3001 JOE DIMAGGIO BLVD STE 900B
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City | ROUND ROCK
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State | TX
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Zip | 78665-3976
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Country | US
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Telephone | 512-729-1800
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Fax |
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Provider Business Mailing Address
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Address Line | 1508 CROCKETT GARDENS RD
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City | GEORGETOWN
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State | TX
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Zip | 78628-4033
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Country | US
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Telephone | 512-585-8468
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Fax |
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Authorized Official
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Title or Position | OWNERSHIP MEMBER
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Name | MRS. BONNY PETTY
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Credential | PA-C
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Telephone | 512-585-8468
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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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 | 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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