MEDICARE: ELEVATED PATHWAYS 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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1700452604
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELEVATED PATHWAYS LLC

Provider Business Mailing Address
First Line	:	999 N PEARL ST APT 104
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80203-3245
Country	:	US
Telephone Number	:	720-295-9807
Fax Number	:

Provider Business Practice Location Address
First Line	:	999 N PEARL ST APT 104
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80203-3245
Country	:	US
Telephone Number	:	720-295-9807
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PROVIDER
Name	:	LAURA BURT
Credential	:	LPC
Telephone Number	:	720-295-9807

Provider Enumeration Date	:	06/01/2021
Last Update Date	:	06/01/2021

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Directions to “ELEVATED PATHWAYS LLC ” Practice Location

Language	Start Address	Practice Location

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