MEDICARE: ELEVATE CREATIVE PSYCHOTHERAPY AND MOVEMENT ARTS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0855X	Adolescent and Children Mental Health Clinic/Center
2	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1083410021
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELEVATE CREATIVE PSYCHOTHERAPY AND MOVEMENT ARTS

Provider Business Mailing Address
First Line	:	922 HAVEY RD
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53704-1354
Country	:	US
Telephone Number	:	608-205-8302
Fax Number	:

Provider Business Practice Location Address
First Line	:	4009 FELLAND RD STE 105
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53718-6463
Country	:	US
Telephone Number	:	608-205-8302
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JAMIE L HAMELINK
Credential	:
Telephone Number	:	608-205-8302

Provider Enumeration Date	:	02/20/2025
Last Update Date	:	04/13/2026

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