Provider Demographics
NPI:1063205573
Name:ELEVATED THERAPY FL LLC
Entity type:Organization
Organization Name:ELEVATED THERAPY FL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:NCIOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HEAD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:813-753-6860
Mailing Address - Street 1:4100 W KENNEDY BLVD STE 310
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-2290
Mailing Address - Country:US
Mailing Address - Phone:813-710-5183
Mailing Address - Fax:813-560-8346
Practice Address - Street 1:4100 W KENNEDY BLVD STE 310
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-2290
Practice Address - Country:US
Practice Address - Phone:813-710-5183
Practice Address - Fax:813-560-8346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-27
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty