Provider Demographics
NPI:1629789854
Name:ELEVATING AWARENESS THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:ELEVATING AWARENESS THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LMFT
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARKE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMFT
Authorized Official - Phone:319-621-5300
Mailing Address - Street 1:3641 KIMBALL AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-5757
Mailing Address - Country:US
Mailing Address - Phone:319-318-0178
Mailing Address - Fax:319-320-1121
Practice Address - Street 1:3641 KIMBALL AVE STE 207
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-5757
Practice Address - Country:US
Practice Address - Phone:319-318-0178
Practice Address - Fax:319-320-1121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-08
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health