Provider Demographics
NPI:1033140306
Name:ELDER, WILLIAM GIBBS JR (PHD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:GIBBS
Last Name:ELDER
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4349 MARTIN LUTHER KING BLVD HEALTH 2 BLDG SUITE 1001E
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77204-0001
Mailing Address - Country:US
Mailing Address - Phone:713-743-9682
Mailing Address - Fax:713-743-1049
Practice Address - Street 1:4349 MARTIN LUTHER KING BLVD HEALTH 2 BLDG SUITE 1001E
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77204-2043
Practice Address - Country:US
Practice Address - Phone:713-743-9682
Practice Address - Fax:713-743-1049
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1108103TC0700X
TX38344103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY89011084Medicaid
KY89011084Medicaid
0621201Medicare ID - Type Unspecified