Provider Demographics
NPI:1730909607
Name:LIFT YOUR MIND LLC
Entity type:Organization
Organization Name:LIFT YOUR MIND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAZULAK
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:717-500-1708
Mailing Address - Street 1:3300 BOARD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17406-8409
Mailing Address - Country:US
Mailing Address - Phone:717-500-1708
Mailing Address - Fax:223-877-3656
Practice Address - Street 1:3300 BOARD RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17406-8409
Practice Address - Country:US
Practice Address - Phone:717-500-1708
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-15
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)