Provider Demographics
NPI:1306484886
Name:ELEVO COUNSELING & COACHING
Entity type:Organization
Organization Name:ELEVO COUNSELING & COACHING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMFT
Authorized Official - Phone:801-301-2450
Mailing Address - Street 1:2940 W MAPLE LOOP DR STE L13
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-6097
Mailing Address - Country:US
Mailing Address - Phone:801-335-5378
Mailing Address - Fax:
Practice Address - Street 1:2940 W MAPLE LOOP DR STE L13
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-6097
Practice Address - Country:US
Practice Address - Phone:801-335-5378
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-16
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)