Elevate Wellness, LLC

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

License

R4844 Issued in OR

Legal business name

ELEVATE WELLNESS, LLC

Practice address

6700 SW 105TH Ave Ste 203
Beaverton, OR 97008-8824

Phone

(503) 435-7663

NPI assigned

Sep 28, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Heather Denise Glenn, LPC INTERN, NCC, CRC

Title

Owner

Phone

(541) 337-6381

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1506556800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1356850697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6700 SW 105TH AVE STE 203",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970088824",
            "telephone_number": "503-435-7663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6700 SW 105TH AVE STE 203",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970088824",
            "telephone_number": "503-435-7663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELEVATE WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-28",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "GLENN",
        "authorized_official_first_name": "HEATHER",
        "authorized_official_middle_name": "DENISE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "541-337-6381",
        "authorized_official_credential": "LPC INTERN, NCC, CRC"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "OR",
            "license": "R4844",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelli Murdock Eickelberg, MA, CCC-SLP
• Brittany Shannon Eide, LPC INTERN
• Lena Eidi
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• Kristen Rene Ell, MD

• Adult Mental Health Clinic/Center in Beaverton, OR
• Providers in Beaverton, OR by specialty
• Adult Mental Health Clinic/Center in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.