Provider Demographics
NPI:1164937603
Name:MCELROY, JERRY LYNN (MED,LISAC)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:LYNN
Last Name:MCELROY
Suffix:
Gender:M
Credentials:MED,LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5811 W ELECTRA LN
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85310-3637
Mailing Address - Country:US
Mailing Address - Phone:480-544-0411
Mailing Address - Fax:
Practice Address - Street 1:1830 S ALMA SCHOOL RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-3056
Practice Address - Country:US
Practice Address - Phone:480-649-3352
Practice Address - Fax:480-649-3358
Is Sole Proprietor?:No
Enumeration Date:2017-12-06
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSA-1559101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZSA-1559OtherAZ BOARD OF BEHAVIORAL HEALTH EXAMINERS