Provider Demographics
NPI:1992401376
Name:ELITE BEHAVIORAL THERAPY
Entity type:Organization
Organization Name:ELITE BEHAVIORAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW LICENSED PSYCHOTHERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MIRTA
Authorized Official - Middle Name:ELVIRE
Authorized Official - Last Name:INNIS-THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW,LICSW,DSW
Authorized Official - Phone:202-763-9178
Mailing Address - Street 1:11140 ROCKVILLE PIKE STE 480-E
Mailing Address - Street 2:SUITE 480-E
Mailing Address - City:NORTH BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3106
Mailing Address - Country:US
Mailing Address - Phone:240-408-7582
Mailing Address - Fax:240-403-7629
Practice Address - Street 1:11140 ROCKVILLE PIKE STE 480-E
Practice Address - Street 2:
Practice Address - City:NORTH BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20852-3106
Practice Address - Country:US
Practice Address - Phone:240-403-7582
Practice Address - Fax:240-403-7629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-06
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty