Provider Demographics
NPI:1508678582
Name:ELEVATED THERAPY SOLUTIONS
Entity type:Organization
Organization Name:ELEVATED THERAPY SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRACTIONER
Authorized Official - Prefix:
Authorized Official - First Name:JENELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:952-522-3132
Mailing Address - Street 1:18315 CASCADE DR STE 170
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55347-1184
Mailing Address - Country:US
Mailing Address - Phone:952-522-3132
Mailing Address - Fax:952-333-7156
Practice Address - Street 1:18315 CASCADE DR STE 170
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55347-1184
Practice Address - Country:US
Practice Address - Phone:952-522-3132
Practice Address - Fax:952-333-7156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-24
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty