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General NPI Number Information
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NPI Number | 1396674214
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Entity Type | Organization
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Legal Business Name | ELEVATE MIND & BODY WELLNESS CLINIC LLC
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Dates
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Enumeration Date | 05/16/2026
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Last Update Date | 05/16/2026
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Provider Practice Location Address
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Address Line | 4801 SOUTHWICK DR STE 630-H
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City | MATTESON
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State | IL
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Zip | 60443-2254
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Country | US
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Telephone | 708-793-3430
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Fax |
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Provider Business Mailing Address
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Address Line | 4801 SOUTHWICK DR STE 630-H
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City | MATTESON
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State | IL
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Zip | 60443-2254
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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 | KARA TALIAFERRO
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Credential | NP
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Telephone | 708-269-3121
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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