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General NPI Number Information
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NPI Number | 1063205573
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Entity Type | Organization
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Legal Business Name | ELEVATED THERAPY FL LLC
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Dates
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Enumeration Date | 05/27/2025
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Last Update Date | 05/27/2025
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Provider Practice Location Address
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Address Line | 4100 W KENNEDY BLVD STE 310
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City | TAMPA
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State | FL
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Zip | 33609-2290
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Country | US
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Telephone | 813-710-5183
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Fax | 813-560-8346
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Provider Business Mailing Address
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Address Line | 4100 W KENNEDY BLVD STE 310
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City | TAMPA
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State | FL
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Zip | 33609-2290
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Country | US
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Telephone | 813-710-5183
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Fax | 813-560-8346
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Authorized Official
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Title or Position | OWNER/PSYCHOTHERAPIST
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Name | NCIOLE HEAD
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Credential | LCSW
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Telephone | 813-753-6860
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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