MEDICARE: ELEVATE HEALTHCARE - WYLIE 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	261QM0855X	Adolescent and Children Mental Health Clinic/Center
3	283Q00000X	Psychiatric Hospital
4	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1801466578
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELEVATE HEALTHCARE - WYLIE LLC

Provider Business Mailing Address
First Line	:	18333 PRESTON RD STE 310
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75252-6144
Country	:	US
Telephone Number	:	214-396-0717
Fax Number	:	469-372-0129

Provider Business Practice Location Address
First Line	:	611 S HIGHWAY 78 STE 103
Second Line	:
City	:	WYLIE
State	:	TX
Zip	:	75098-4084
Country	:	US
Telephone Number	:	469-661-9204
Fax Number	:	469-661-9179

Authorized Official
Title or Position	:	FOUNDER/PRESIDENT
Name	:	MARGIE BARILLA
Credential	:
Telephone Number	:	214-843-8503

Provider Enumeration Date	:	06/25/2021
Last Update Date	:	06/25/2021

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