MEDICARE: ELSYIAN PATH LLC

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

General Provider Information

NPI Number	:	1427949684
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELSYIAN PATH LLC

Provider Business Mailing Address
First Line	:	9501 WHITE FIR GROVE CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89143-1262
Country	:	US
Telephone Number	:	602-616-8275
Fax Number	:

Provider Business Practice Location Address
First Line	:	9501 WHITE FIR GROVE CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89143-1262
Country	:	US
Telephone Number	:	602-616-8275
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JUSTIN MCGUIRE
Credential	:
Telephone Number	:	602-616-8275

Provider Enumeration Date	:	07/14/2025
Last Update Date	:	05/11/2026

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