Provider Demographics
NPI:1013730134
Name:ELEVATE METAL HEALTH PLLC
Entity type:Organization
Organization Name:ELEVATE METAL HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNERSHIP MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BONNY
Authorized Official - Middle Name:
Authorized Official - Last Name:PETTY
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:512-585-8468
Mailing Address - Street 1:1508 CROCKETT GARDENS RD
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-4033
Mailing Address - Country:US
Mailing Address - Phone:512-585-8468
Mailing Address - Fax:
Practice Address - Street 1:3001 JOE DIMAGGIO BLVD STE 900B
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-3976
Practice Address - Country:US
Practice Address - Phone:512-729-1800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-06
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty