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General NPI Number Information
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NPI Number | 1548047681
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Entity Type | Organization
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Legal Business Name | ELEVATE, INC.
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Dates
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Enumeration Date | 09/12/2023
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Last Update Date | 09/12/2023
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Provider Practice Location Address
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Address Line | 1626 CLARENCE CT
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City | WEST BEND
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State | WI
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Zip | 53095-8533
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Country | US
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Telephone | 262-677-2216
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Fax |
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Provider Business Mailing Address
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Address Line | N169W21005 MEADOW LN
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City | JACKSON
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State | WI
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Zip | 53037-8622
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Country | US
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Telephone | 262-677-2216
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MARY SIMON
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Credential |
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Telephone | 262-677-2216
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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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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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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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