Healthcare Provider Details

I. General information

NPI: 1902881550
Provider Name (Legal Business Name): JOHN V ELWOOD PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 04/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 SW H K DODGEN LOOP SUITE 110
TEMPLE TX
76502-1838
US

IV. Provider business mailing address

PO BOX 938
KILLEEN TX
76540-0938
US

V. Phone/Fax

Practice location:
  • Phone: 254-791-8900
  • Fax: 254-200-4090
Mailing address:
  • Phone: 254-634-6999
  • Fax: 254-200-4090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number22427
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number6090
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: