Provider Demographics
NPI:1306693593
Name:ELEVATING MENTAL HEALTH, A PROFESSIONAL NURSING CORPORATION
Entity type:Organization
Organization Name:ELEVATING MENTAL HEALTH, A PROFESSIONAL NURSING CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:KLUCZINSKE
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:315-413-9877
Mailing Address - Street 1:830 STEWART DR STE 271
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94085-4513
Mailing Address - Country:US
Mailing Address - Phone:498-400-3967
Mailing Address - Fax:
Practice Address - Street 1:830 STEWART DR STE 271
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94085-4513
Practice Address - Country:US
Practice Address - Phone:498-400-3967
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-04
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty