Provider Demographics
NPI:1679348221
Name:ELSTON PSYCHOTHERAPY LLC
Entity type:Organization
Organization Name:ELSTON PSYCHOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:RETHA
Authorized Official - Last Name:ELSTON
Authorized Official - Suffix:
Authorized Official - Credentials:DRPH (C), LCSW, MBA
Authorized Official - Phone:815-535-6041
Mailing Address - Street 1:614 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:IL
Mailing Address - Zip Code:61081-2248
Mailing Address - Country:US
Mailing Address - Phone:815-535-6041
Mailing Address - Fax:
Practice Address - Street 1:614 W 9TH ST
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:IL
Practice Address - Zip Code:61081-2248
Practice Address - Country:US
Practice Address - Phone:815-535-6041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-22
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Single Specialty