MEDICARE: ELEVATED COUNSELING SERVICES 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	:	1619548625
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELEVATED COUNSELING SERVICES LLC

Provider Business Mailing Address
First Line	:	17460 I-35 NORTH SUITE 430 378
Second Line	:
City	:	SCHERTZ
State	:	TX
Zip	:	78154
Country	:	US
Telephone Number	:	210-660-8679
Fax Number	:

Provider Business Practice Location Address
First Line	:	1777 NE LOOP 410 STE 600-675
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78217-5209
Country	:	US
Telephone Number	:	108-644-9362
Fax Number	:	239-494-8397

Authorized Official
Title or Position	:	LCSW/MANAGING MEMBER
Name	:	EBONY PORTIS
Credential	:	LCSW
Telephone Number	:	210-864-4936

Provider Enumeration Date	:	07/09/2021
Last Update Date	:	11/10/2021

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