Provider Demographics
NPI:1508457177
Name:ELEVATE FAMILY COUNSELING CENTER PC
Entity Type:Organization
Organization Name:ELEVATE FAMILY COUNSELING CENTER PC
Other - Org Name:ELEVATE COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:LICURSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-228-4767
Mailing Address - Street 1:1588 HOMESTEAD RD STE A
Mailing Address - Street 2:M/B 5
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95050-4783
Mailing Address - Country:US
Mailing Address - Phone:408-774-1009
Mailing Address - Fax:
Practice Address - Street 1:1588 HOMESTEAD RD STE A
Practice Address - Street 2:M/B 5
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050-4783
Practice Address - Country:US
Practice Address - Phone:408-288-4767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-27
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)