Healthcare Provider Details

I. General information

NPI: 1821979675
Provider Name (Legal Business Name): ELEMENTAL SELF INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 N NEVILLE ST STE 102
PITTSBURGH PA
15213-2853
US

IV. Provider business mailing address

586 HAZELWOOD AVE
PITTSBURGH PA
15207-1231
US

V. Phone/Fax

Practice location:
  • Phone: 412-475-8122
  • Fax:
Mailing address:
  • Phone: 412-779-2475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ERIN ELIZABETH KELLY
Title or Position: OWNER
Credential: LCSW, REAT, RYT-500
Phone: 412-779-2475