Healthcare Provider Details

I. General information

NPI: 1043123201
Provider Name (Legal Business Name): ELEVARE IN MISSISSIPPI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3621 26TH ST
MERIDIAN MS
39307-4547
US

IV. Provider business mailing address

3621 26TH ST
MERIDIAN MS
39307-4547
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 Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: CHANTEL WHITE
Title or Position: CO-OWNER/CHIEF CLINICAL OFFICER
Credential: LCSW
Phone: 317-563-1117