MEDICARE: ETHAN ELSTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst		LA

General Provider Information

NPI Number	:	1740052323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ETHAN ELSTON

Provider Business Mailing Address
First Line	:	1768 78TH AVE
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70807-5417
Country	:	US
Telephone Number	:	225-380-4752
Fax Number	:

Provider Business Practice Location Address
First Line	:	1768 78TH AVE
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70807-5417
Country	:	US
Telephone Number	:	225-380-4752
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2023
Last Update Date	:	10/26/2023

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Directions to “ ETHAN ELSTON ” Practice Location

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