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General NPI Number Information
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NPI Number | 1770169633
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Entity Type | Organization
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Legal Business Name | ELEVATE COUNSELING CENTER, LLC
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Dates
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Enumeration Date | 03/22/2021
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Last Update Date | 03/22/2021
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Provider Practice Location Address
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Address Line | 1588 HOMESTEAD RD MIB 5
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City | SANTA CLARA
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State | CA
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Zip | 95050-4783
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Country | US
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Telephone | 408-288-4767
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Fax | 408-249-2291
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Provider Business Mailing Address
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Address Line | 1588 HOMESTEAD RD MIB 5
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City | SANTA CLARA
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State | CA
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Zip | 95050-4783
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Country | US
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Telephone | 408-288-4767
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Fax | 408-249-2291
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Authorized Official
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Title or Position | OWNER/ DIRECTOR
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Name | MS. DEBORAH ANN LICURSE
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Credential | MFT, M.A.
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Telephone | 408-288-5767
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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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