Healthcare Provider Details

I. General information

NPI: 1760322325
Provider Name (Legal Business Name): ELEVARE IN KENTUCKY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 N 2ND ST STE 100
RICHMOND KY
40475-1408
US

IV. Provider business mailing address

212 N 2ND ST STE 100
RICHMOND KY
40475-1408
US

V. Phone/Fax

Practice location:
  • Phone: 317-563-1117
  • Fax: 317-608-3436
Mailing address:
  • Phone: 317-563-1117
  • Fax: 317-608-3436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CHANTEL SHANISE WHITE
Title or Position: OWNER
Credential: LCSW
Phone: 463-330-9255