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General NPI Number Information
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NPI Number | 1376495044
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Entity Type | Organization
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Legal Business Name | ELEVATION ETX PLLC
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Dates
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Enumeration Date | 02/13/2026
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Last Update Date | 02/13/2026
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Provider Practice Location Address
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Address Line | 2341 DUELING OAKS DR STE 200
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City | TYLER
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State | TX
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Zip | 75703-0328
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Country | US
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Telephone | 903-258-1675
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Fax |
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Provider Business Mailing Address
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Address Line | 2341 DUELING OAKS DR STE 200
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City | TYLER
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State | TX
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Zip | 75703-0328
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Country | US
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Telephone | 903-258-1675
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SUSAN BROOKE BAGWELL
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Credential | LPC
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Telephone | 903-258-1675
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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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