Organization
ELEVATE METAL HEALTH PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BONNY PETTY PA-C (OWNERSHIP MEMBER)
(512) 585-8468
Entity
Organization
Contact information
Practice address
3001 JOE DIMAGGIO BLVD STE 900B, ROUND ROCK, TX 78665-3976
(512) 729-1800
Mailing address
1508 CROCKETT GARDENS RD, GEORGETOWN, TX 78628-4033
(512) 585-8468
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
363AM0700X
Medical Physician Assistant
—
—
Other
Enumeration date
11/06/2024
Last updated
01/29/2025
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