Provider Demographics
NPI:1952506917
Name:ELDRIDGE, JOHN PAUL
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:PAUL
Last Name:ELDRIDGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 TEXAS BLVD
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75501-3866
Mailing Address - Country:US
Mailing Address - Phone:903-832-2860
Mailing Address - Fax:903-832-2870
Practice Address - Street 1:2110 TEXAS BLVD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75501-3866
Practice Address - Country:US
Practice Address - Phone:903-832-2860
Practice Address - Fax:903-832-2870
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX833-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical