| Elevatelife Therapy & Consulting, Licensed Clinical Social Worker, Inc | |
|
145 S Fairfax Ave Ste 200 Los Angeles CA 90036-2186 | |
| (323) 968-6404 | |
| (213) 315-4859 |
| Full Name | Elevatelife Therapy & Consulting, Licensed Clinical Social Worker, Inc |
|---|---|
| Speciality | Social Worker |
| Location | 145 S Fairfax Ave Ste 200, Los Angeles, California |
| Authorized Official Name and Position | Angelique D York (OWNER) |
| Authorized Official Contact | 3239686404 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Elevatelife Therapy & Consulting, Licensed Clinical Social Worker, Inc 145 S Fairfax Ave Ste 200 Los Angeles CA 90036-2186 Ph: (323) 968-6404 | Elevatelife Therapy & Consulting, Licensed Clinical Social Worker, Inc 145 S Fairfax Ave Ste 200 Los Angeles CA 90036-2186 Ph: (323) 968-6404 |
| NPI Number | 1457133357 |
|---|---|
| Provider Enumeration Date | 10/16/2023 |
| Last Update Date | 11/13/2023 |
| Certification Date | 10/23/2023 |
| Medicare PECOS PAC ID | 0547602708 |
|---|---|
| Medicare Enrollment ID | O20240521000307 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457133357 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Angelique D York |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417678152 PECOS PAC ID: 3779946314 Enrollment ID: I20230829003445 |
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