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General NPI Number Information
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NPI Number | 1083410021
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Entity Type | Organization
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Legal Business Name | ELEVATE CREATIVE PSYCHOTHERAPY AND MOVEMENT ARTS, LLC
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Dates
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Enumeration Date | 02/20/2025
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Last Update Date | 02/20/2025
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Provider Practice Location Address
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Address Line | 4009 FELLAND RD STE 105
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City | MADISON
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State | WI
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Zip | 53718-6463
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Country | US
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Telephone | 608-205-8302
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Fax |
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Provider Business Mailing Address
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Address Line | 922 HAVEY RD
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City | MADISON
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State | WI
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Zip | 53704-1354
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Country | US
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Telephone | 608-205-8302
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | JAMIE HAMELINK
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Credential | LPC
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Telephone | 608-205-8302
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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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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