Provider Demographics
NPI:1568069128
Name:ELEVATE THERAPY
Entity Type:Organization
Organization Name:ELEVATE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RALIAT
Authorized Official - Middle Name:Q
Authorized Official - Last Name:ADEBOYEJO
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:217-512-0346
Mailing Address - Street 1:1564 N DAMEN AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-2102
Mailing Address - Country:US
Mailing Address - Phone:217-512-0346
Mailing Address - Fax:
Practice Address - Street 1:1564 N DAMEN AVE STE 208
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-2102
Practice Address - Country:US
Practice Address - Phone:217-512-0346
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-07
Last Update Date:2021-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty