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General NPI Number Information
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NPI Number | 1043123201
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Entity Type | Organization
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Legal Business Name | ELEVARE IN MISSISSIPPI, LLC
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Dates
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Enumeration Date | 09/28/2026
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Last Update Date | 09/28/2026
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Provider Practice Location Address
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Address Line | 3621 26TH ST
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City | MERIDIAN
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State | MS
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Zip | 39307-4547
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Country | US
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Telephone | 317-563-1117
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Fax | 317-608-3436
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Provider Business Mailing Address
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Address Line | 3621 26TH ST
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City | MERIDIAN
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State | MS
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Zip | 39307-4547
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Country | US
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Telephone | 317-563-1117
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Fax | 317-608-3436
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Authorized Official
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Title or Position | CO-OWNER/CHIEF CLINICAL OFFICER
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Name | CHANTEL WHITE
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Credential | LCSW
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Telephone | 317-563-1117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State | NULL
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