MEDICARE: UPLIFT THERAPY, LLC.

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1467384537
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UPLIFT THERAPY, LLC.

Provider Business Mailing Address
First Line	:	21 OLD SCHOOL RD STE 1
Second Line	:
City	:	SELINSGROVE
State	:	PA
Zip	:	17870-8914
Country	:	US
Telephone Number	:	570-850-6966
Fax Number	:

Provider Business Practice Location Address
First Line	:	21 OLD SCHOOL RD STE 1
Second Line	:
City	:	SELINSGROVE
State	:	PA
Zip	:	17870-8914
Country	:	US
Telephone Number	:	570-850-6966
Fax Number	:

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	ANGELIA THOMAS
Credential	:	LCSW
Telephone Number	:	570-850-6966

Provider Enumeration Date	:	06/02/2026
Last Update Date	:	06/02/2026

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