Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 57843642501 | UT |
NPI | 1013308055 |
---|---|
Provider Name | Dr. William Elder |
First Address | San Antonio, TX 78230-1140 |
Second Address | San Antonio, TX 78240-3900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2015 |
Last Update Date | 12/02/2015 |