Healthcare Provider Details

I. General information

NPI: 1952967630
Provider Name (Legal Business Name): ASHLI NICHOLE ELSEY MA, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2019
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1389 W 86TH ST # 170
INDIANAPOLIS IN
46260-2101
US

IV. Provider business mailing address

2047 N COUNTY ROAD 600 E
AVON IN
46123-9533
US

V. Phone/Fax

Practice location:
  • Phone: 317-409-6151
  • Fax:
Mailing address:
  • Phone: 765-242-4196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-19-34747
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: