MEDICARE: ELENA EVERTSON

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	1-26-89854	TX

General Provider Information

NPI Number	:	1154252112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELENA EVERTSON

Provider Business Mailing Address
First Line	:	12700 HILLCREST RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-2033
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12700 HILLCREST RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-2033
Country	:	US
Telephone Number	:	945-277-2307
Fax Number	:

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

Provider Enumeration Date	:	05/28/2026
Last Update Date	:	05/28/2026

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Directions to “ ELENA EVERTSON ” Practice Location

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