Provider Demographics
NPI:1285192294
Name:ELEVATION EMPOWERMENT SERVICES LLC
Entity Type:Organization
Organization Name:ELEVATION EMPOWERMENT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOCIAL WORK PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LATANYA
Authorized Official - Middle Name:TAUNNETTE
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:231-224-6886
Mailing Address - Street 1:1328 LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442
Mailing Address - Country:US
Mailing Address - Phone:231-638-2027
Mailing Address - Fax:
Practice Address - Street 1:800 E ELLIS RD
Practice Address - Street 2:
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49441-5646
Practice Address - Country:US
Practice Address - Phone:231-224-6886
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-08
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty