Provider Demographics
NPI:1851023667
Name:ELEVATED COUNSELING AND WELLNESS LLC
Entity type:Organization
Organization Name:ELEVATED COUNSELING AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:K
Authorized Official - Last Name:STUM
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:435-574-9193
Mailing Address - Street 1:PO BOX 911763
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84791-1763
Mailing Address - Country:US
Mailing Address - Phone:435-574-9193
Mailing Address - Fax:
Practice Address - Street 1:163 W 1600 S STE 3
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-6715
Practice Address - Country:US
Practice Address - Phone:435-216-8839
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-29
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)