Provider Demographics
NPI:1063013167
Name:ELEVATED YOUTH SERVICES
Entity Type:Organization
Organization Name:ELEVATED YOUTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:B
Authorized Official - Last Name:BROWNING
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-907-5622
Mailing Address - Street 1:10928 S EUREKA DUNE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84009-4173
Mailing Address - Country:US
Mailing Address - Phone:801-907-5622
Mailing Address - Fax:
Practice Address - Street 1:10928 S EUREKA DUNE DR
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84009-4173
Practice Address - Country:US
Practice Address - Phone:801-508-4756
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children