Provider Demographics
NPI:1356850697
Name:ELEVATE WELLNESS, LLC
Entity Type:Organization
Organization Name:ELEVATE WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:GLENN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC INTERN, NCC, CRC
Authorized Official - Phone:541-337-6381
Mailing Address - Street 1:6700 SW 105TH AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-8824
Mailing Address - Country:US
Mailing Address - Phone:503-435-7663
Mailing Address - Fax:
Practice Address - Street 1:6700 SW 105TH AVE STE 203
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-8824
Practice Address - Country:US
Practice Address - Phone:503-435-7663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR4844261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health