Provider Demographics
NPI:1770270597
Name:ELEVATION INDIVIDUAL AND FAMILY THERAPY PLLC
Entity type:Organization
Organization Name:ELEVATION INDIVIDUAL AND FAMILY THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:708-513-8170
Mailing Address - Street 1:19150 KEDZIE AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-4541
Mailing Address - Country:US
Mailing Address - Phone:708-300-8864
Mailing Address - Fax:779-201-9643
Practice Address - Street 1:19150 KEDZIE AVE STE 201
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-4541
Practice Address - Country:US
Practice Address - Phone:708-300-8864
Practice Address - Fax:779-201-9643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-21
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health