Provider Demographics
NPI:1972775617
Name:ELDER, TERRYA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TERRYA
Middle Name:
Last Name:ELDER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 S SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611-7939
Mailing Address - Country:US
Mailing Address - Phone:907-283-7635
Mailing Address - Fax:907-283-9575
Practice Address - Street 1:320 S SPRUCE ST
Practice Address - Street 2:
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611-7939
Practice Address - Country:US
Practice Address - Phone:907-283-7635
Practice Address - Fax:907-283-9575
Is Sole Proprietor?:No
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1041CO700X1041C0700X
AK8021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1952440570Medicaid