Provider Demographics
NPI:1922756758
Name:ELEVATED THERAPEUTIC SOLUTIONS, LLC
Entity Type:Organization
Organization Name:ELEVATED THERAPEUTIC SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:FARMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-284-1058
Mailing Address - Street 1:7004 DRURY DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40229-2899
Mailing Address - Country:US
Mailing Address - Phone:512-284-1058
Mailing Address - Fax:502-754-4413
Practice Address - Street 1:4169 WESTPORT RD STE 120
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-2747
Practice Address - Country:US
Practice Address - Phone:502-333-9466
Practice Address - Fax:502-754-4413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-10
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty