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General NPI Number Information
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NPI Number | 1184546434
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Entity Type | Organization
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Legal Business Name | ELEVATE SUPPORT SERVICES LLC
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Dates
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Enumeration Date | 07/28/2026
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Last Update Date | 07/28/2026
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Provider Practice Location Address
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Address Line | 19060 EVERETT BLVD UNIT 204
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City | MOKENA
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State | IL
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Zip | 60448-2501
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Country | US
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Telephone | 708-268-6406
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Fax |
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Provider Business Mailing Address
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Address Line | 19060 EVERETT BLVD UNIT 204
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City | MOKENA
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State | IL
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Zip | 60448-2501
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. PATRICK O'MALLEY III
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Credential | M.A., BCBA
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Telephone | 708-268-6406
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional 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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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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 | 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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