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General NPI Number Information
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NPI Number | 1619548625
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Entity Type | Organization
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Legal Business Name | ELEVATED COUNSELING SERVICES LLC
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Dates
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Enumeration Date | 07/09/2021
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Last Update Date | 11/10/2021
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Provider Practice Location Address
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Address Line | 1777 NE LOOP 410 STE 600-675
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City | SAN ANTONIO
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State | TX
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Zip | 78217-5209
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Country | US
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Telephone | 108-644-9362
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Fax | 239-494-8397
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Provider Business Mailing Address
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Address Line | 17460 I-35 NORTH SUITE 430 378
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City | SCHERTZ
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State | TX
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Zip | 78154
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Country | US
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Telephone | 210-660-8679
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Fax |
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Authorized Official
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Title or Position | LCSW/MANAGING MEMBER
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Name | EBONY PORTIS
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Credential | LCSW
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Telephone | 210-864-4936
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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