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General NPI Number Information
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NPI Number | 1770217614
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Entity Type | Organization
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Legal Business Name | ELEVATED LIFE THERAPY, PLLC
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Dates
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Enumeration Date | 07/15/2022
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Last Update Date | 07/15/2022
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Provider Practice Location Address
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Address Line | 105 E MAIN ST STE 307
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City | MORRIS
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State | IL
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Zip | 60450-2149
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Country | US
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Telephone | 815-661-6257
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Fax |
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Provider Business Mailing Address
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Address Line | 401 E JEFFERSON ST
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City | GARDNER
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State | IL
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Zip | 60424-7011
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Country | US
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Telephone | 815-250-7525
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Fax |
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Authorized Official
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Title or Position | LCPC
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Name | RAEANN LOWRY
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Credential |
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Telephone | 815-250-7525
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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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