Provider Demographics
NPI:1871101014
Name:TMS ELEVATED
Entity type:Organization
Organization Name:TMS ELEVATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ-LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:385-441-3004
Mailing Address - Street 1:1790 SUN PEAK DR STE B105
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-6625
Mailing Address - Country:US
Mailing Address - Phone:385-441-3004
Mailing Address - Fax:435-602-1131
Practice Address - Street 1:1790 SUN PEAK DR STE B105
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098-6625
Practice Address - Country:US
Practice Address - Phone:385-441-3004
Practice Address - Fax:435-602-1131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty