Healthcare Provider Details

I. General information

NPI: 1942912647
Provider Name (Legal Business Name): ELONZO STROUD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2022
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14804 N CAVE CREEK RD # 108
PHOENIX AZ
85032-4945
US

IV. Provider business mailing address

2744 YURMAN RD
CHARLOTTE NC
28214-5602
US

V. Phone/Fax

Practice location:
  • Phone: 602-341-5434
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: