Organization
ELEVATE WELLNESS COUNSELING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACOB RUSSELL MOSS LCSW (MEMBER)
(801) 867-5838
Entity
Organization
Contact information
Practice address
1100 SW 6TH AVE STE 1600, PORTLAND, OR 97204-1017
(801) 867-5838
Mailing address
2850 SW CEDAR HILLS BLVD # 1110, BEAVERTON, OR 97005-1354
(801) 867-5838
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
03/19/2025
Last updated
03/19/2025
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