MEDICARE: ELEVATED MINDS COUNSELING 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	:	1770431314
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELEVATED MINDS COUNSELING LLC

Provider Business Mailing Address
First Line	:	6147 JEFFERSON AVE
Second Line	:
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23605-1511
Country	:	US
Telephone Number	:	757-826-1300
Fax Number	:	757-826-1300

Provider Business Practice Location Address
First Line	:	6147 JEFFERSON AVE
Second Line	:
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23605-1511
Country	:	US
Telephone Number	:	757-826-1300
Fax Number	:	757-826-1300

Authorized Official
Title or Position	:	OWNER/PROPRIETOR
Name	:	MATTHEW L BRADLEY JR.
Credential	:	LCSW
Telephone Number	:	757-826-1300

Provider Enumeration Date	:	03/19/2026
Last Update Date	:	03/19/2026

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