Provider Demographics
NPI:1174348858
Name:ELEVATE MENTAL HEALTH AND WELLNESS LLC
Entity type:Organization
Organization Name:ELEVATE MENTAL HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MORGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HALTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-419-8531
Mailing Address - Street 1:305 KINGSLEY LAKE DR STE 702
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-3045
Mailing Address - Country:US
Mailing Address - Phone:904-419-8531
Mailing Address - Fax:
Practice Address - Street 1:305 KINGSLEY LAKE DR STE 702
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-3045
Practice Address - Country:US
Practice Address - Phone:904-419-8531
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health