MEDICARE: ELEVATED BEHAVIORAL AND TRANSITIONAL CARE PPLC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1760308944
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELEVATED BEHAVIORAL AND TRANSITIONAL CARE PPLC

Provider Business Mailing Address
First Line	:	1012 ERVIN LN
Second Line	:
City	:	MESQUITE
State	:	TX
Zip	:	75149-3843
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1012 ERVIN LN
Second Line	:
City	:	MESQUITE
State	:	TX
Zip	:	75149-3843
Country	:	US
Telephone Number	:	469-441-3112
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	LAWSON IDON
Credential	:	PMHNP-BC
Telephone Number	:	469-441-3112

Provider Enumeration Date	:	06/24/2026
Last Update Date	:	06/24/2026

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