Provider Demographics
NPI:1528539095
Name:ELEVATED GROUPS COUNSELING LLC
Entity Type:Organization
Organization Name:ELEVATED GROUPS COUNSELING LLC
Other - Org Name:ELEVATED GROUPS COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO AND DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:
Authorized Official - Last Name:TARAWNEH
Authorized Official - Suffix:
Authorized Official - Credentials:EDD CADC
Authorized Official - Phone:708-444-0304
Mailing Address - Street 1:10436 SOUTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60415-2282
Mailing Address - Country:US
Mailing Address - Phone:708-444-0304
Mailing Address - Fax:
Practice Address - Street 1:10436 SOUTHWEST HWY
Practice Address - Street 2:
Practice Address - City:CHICAGO RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60415-2282
Practice Address - Country:US
Practice Address - Phone:708-444-0304
Practice Address - Fax:708-377-3960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-10
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use DisorderGroup - Single Specialty