1619548625 NPI number — ELEVATED COUNSELING SERVICES LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619548625 NPI number — ELEVATED COUNSELING SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELEVATED COUNSELING SERVICES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619548625
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/10/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17460 I-35 NORTH SUITE 430 378
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCHERTZ
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78154
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-660-8679
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1777 NE LOOP 410 STE 600-675
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78217-5209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
108-644-9362
Provider Business Practice Location Address Fax Number:
239-494-8397
Provider Enumeration Date:
07/09/2021

Additional Information

Authorized Official

Authorized Official Last Name:
PORTIS
Authorized Official First Name:
EBONY
Authorized Official Middle Name:
Authorized Official Title or Position:
LCSW/MANAGING MEMBER
Authorized Official Telephone Number:
210-864-4936

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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