Provider Demographics
NPI:1003563750
Name:ELEVATION WELLNESS
Entity Type:Organization
Organization Name:ELEVATION WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:INSYXIENGMAY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:225-432-8262
Mailing Address - Street 1:12613 BRISTOL AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70815-6801
Mailing Address - Country:US
Mailing Address - Phone:225-317-2078
Mailing Address - Fax:
Practice Address - Street 1:12613 BRISTOL AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815-6801
Practice Address - Country:US
Practice Address - Phone:225-803-9462
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-02
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty