MEDICARE: THADDEUS ELDER LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	P1312117	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366685315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THADDEUS ELDER LPC

Provider Business Mailing Address
First Line	:	100 RIDGEWAY ST STE 1
Second Line	:
City	:	HOT SPRINGS
State	:	AR
Zip	:	71901-7155
Country	:	US
Telephone Number	:	501-545-6420
Fax Number	:	501-623-2266

Provider Business Practice Location Address
First Line	:	100 RIDGEWAY ST STE 1
Second Line	:
City	:	HOT SPRINGS
State	:	AR
Zip	:	71901-7155
Country	:	US
Telephone Number	:	501-545-6420
Fax Number	:	501-623-2266

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2009
Last Update Date	:	01/02/2025

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Directions to “ THADDEUS ELDER LPC” Practice Location

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