Healthcare Provider Details

I. General information

NPI: 1033140306
Provider Name (Legal Business Name): WILLIAM GIBBS ELDER JR. PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 PRICE RD APT 106
LEXINGTON KY
40511-1980
US

IV. Provider business mailing address

1211 CAROLINE ST UNIT 1403
HOUSTON TX
77002-6937
US

V. Phone/Fax

Practice location:
  • Phone: 859-227-4643
  • Fax:
Mailing address:
  • Phone: 859-227-4643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number38344
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1108
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: