=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033980701
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELEVATION COUNSELING & CONSULTING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/11/2024
-----------------------------------------------------
Last Update Date | 12/12/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3501 DENALI ST STE 205
-----------------------------------------------------
City | ANCHORAGE
-----------------------------------------------------
State | AK
-----------------------------------------------------
Zip | 99503-4039
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 907-227-6167
-----------------------------------------------------
Fax | 844-927-4604
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3501 DENALI ST STE 205
-----------------------------------------------------
City | ANCHORAGE
-----------------------------------------------------
State | AK
-----------------------------------------------------
Zip | 99503-4039
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 907-227-4620
-----------------------------------------------------
Fax | 844-927-4604
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/LICENSED PSYCHOLOGIST
-----------------------------------------------------
Name | CODY CHIPP
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 907-227-6167
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------