Provider Demographics
NPI:1184726416
Name:ELDER, MYRA QUALLS (PHD)
Entity type:Individual
Prefix:DR
First Name:MYRA
Middle Name:QUALLS
Last Name:ELDER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4000
Mailing Address - Street 2:116B2
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:TN
Mailing Address - Zip Code:37684-4000
Mailing Address - Country:US
Mailing Address - Phone:423-926-1171
Mailing Address - Fax:423-979-3447
Practice Address - Street 1:PSYCHOLOGY SERVICE
Practice Address - Street 2:116B2
Practice Address - City:MOUNTAIN HOME
Practice Address - State:TN
Practice Address - Zip Code:37684-4000
Practice Address - Country:US
Practice Address - Phone:423-926-1171
Practice Address - Fax:423-979-3447
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP0000002156103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical