MEDICARE: MR. WILLIAM D MCELFRESH LPC0765

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	101YM0800X	Mental Health Counselor	LPC0765	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LPC0765	OTHER	AZ	THERAPIST
2	LISAC-0266	OTHER	AZ	SUBSTANCE ABUSE COUNSELOR

General Provider Information

NPI Number	:	1801965199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM D MCELFRESH LPC0765

Provider Business Mailing Address
First Line	:	4111 E VALLEY AUTO DR
Second Line	:	SUITE 201
City	:	MESA
State	:	AZ
Zip	:	85206-4605
Country	:	US
Telephone Number	:	480-528-2811
Fax Number	:	480-813-2987

Provider Business Practice Location Address
First Line	:	4111 E VALLEY AUTO DR
Second Line	:	SUITE 201
City	:	MESA
State	:	AZ
Zip	:	85206-4605
Country	:	US
Telephone Number	:	480-528-2811
Fax Number	:	480-813-2987

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

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	07/27/2011

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