Provider Demographics
NPI:1073907333
Name:ELSTON, AMANDA (MA)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:
Last Name:ELSTON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5290 CRISTO DR NE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-8815
Mailing Address - Country:US
Mailing Address - Phone:616-202-2759
Mailing Address - Fax:
Practice Address - Street 1:5290 CRISTO DR NE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-8815
Practice Address - Country:US
Practice Address - Phone:616-202-2759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-25
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6361001292103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist