Provider Demographics
NPI:1619548625
Name:ELEVATED COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:ELEVATED COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW/MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:EBONY
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:210-864-4936
Mailing Address - Street 1:17460 I-35 NORTH SUITE 430 378
Mailing Address - Street 2:
Mailing Address - City:SCHERTZ
Mailing Address - State:TX
Mailing Address - Zip Code:78154
Mailing Address - Country:US
Mailing Address - Phone:210-660-8679
Mailing Address - Fax:
Practice Address - Street 1:1777 NE LOOP 410 STE 600-675
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5209
Practice Address - Country:US
Practice Address - Phone:108-644-9362
Practice Address - Fax:239-494-8397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-09
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty