MEDICARE: ELEVATE HEALTHCARE - OKLAHOMA LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	103TA0400X	Addiction (Substance Use Disorder) Psychologist
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
3	261QM0855X	Adolescent and Children Mental Health Clinic/Center

General Provider Information

NPI Number	:	1659960433
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELEVATE HEALTHCARE - OKLAHOMA LLC

Provider Business Mailing Address
First Line	:	5160 VILLAGE CREEK DR STE 100
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-4423
Country	:	US
Telephone Number	:	214-271-9962
Fax Number	:	214-964-0817

Provider Business Practice Location Address
First Line	:	5160 VILLAGE CREEK DR STE 100
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-4423
Country	:	US
Telephone Number	:	214-271-9962
Fax Number	:	214-964-0817

Authorized Official
Title or Position	:	FOUNDER/PRESIDENT
Name	:	MARGIE BARILLA
Credential	:
Telephone Number	:	214-396-0717

Provider Enumeration Date	:	01/15/2021
Last Update Date	:	08/18/2022

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