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General NPI Number Information
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NPI Number | 1467925396
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Entity Type | Organization
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Legal Business Name | ELEVATION HEALTH SERVICES, LLC
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Dates
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Enumeration Date | 01/03/2019
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Last Update Date | 01/03/2019
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Provider Practice Location Address
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Address Line | 5333 N 7TH ST STE 310B
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City | PHOENIX
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State | AZ
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Zip | 85014-2854
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Country | US
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Telephone | 602-799-2247
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Fax |
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Provider Business Mailing Address
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Address Line | 4 W PINE ST
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City | LODI
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State | CA
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Zip | 95240-2118
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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 | MARK THOMPSON
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Credential |
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Telephone | 602-799-2247
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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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