NPIMap

Organization Active NPI

Elevatemind, LLC

  • Group Psychotherapy Psychologist
  • Hanover, PA
National Provider Identifier
1821845389
Registry record updated May 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Group Psychotherapy PsychologistTaxonomy code 103TP2701X
Legal business name
ELEVATEMIND, LLC
Practice address
100 W Eisenhower Dr Ste a
Hanover, PA 17331-1142
Phone
(717) 632-8400
Fax
(717) 632-9300
NPI assigned
May 2, 2024
Last updated
May 18, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 18, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jesslyn Koloras, PSY.DNPI 1518163872
Title
Co-Owner
Phone
(717) 632-8400

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X NU
Psychologist 103T00000X NU
Group Psychotherapy Psychologist 103TP2701X NU Primary
Health Psychologist 103TH0004X NU

Addresses

Primary practice location

100 W Eisenhower Dr Ste a
Hanover, PA 17331-1142

Mailing address

100 W Eisenhower Dr Ste a
Hanover, PA 17331-1142
Phone (717) 632-8400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240914000571 PA Part B Supplier - Clinic/Group Practice 7113467309 Receives reassigned benefits from 5 practitioners
Practice locations: Hanover, PA

National Provider Directory

National Provider Directory

Locations

100 W Eisenhower Dr
Ste A
Hanover, PA 17331
Phone (717) 632-8400

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1714608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715990400000",
    "number": "1821845389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 W EISENHOWER DR STE A",
            "city": "HANOVER",
            "state": "PA",
            "postal_code": "173311142",
            "telephone_number": "717-632-8400",
            "fax_number": "717-632-9300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 W EISENHOWER DR STE A",
            "city": "HANOVER",
            "state": "PA",
            "postal_code": "173311142",
            "telephone_number": "717-632-8400",
            "fax_number": "717-632-9300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELEVATEMIND, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-02",
        "last_updated": "2024-05-18",
        "certification_date": "2024-05-17",
        "status": "A",
        "authorized_official_last_name": "KOLORAS",
        "authorized_official_first_name": "JESSLYN",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "717-632-8400",
        "authorized_official_credential": "PSY.D"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TP2701X",
            "taxonomy_group": "",
            "desc": "Psychologist, Group Psychotherapy",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "103TH0004X",
            "taxonomy_group": "",
            "desc": "Psychologist, Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hanover, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.