Provider Demographics
NPI:1205987609
Name:ELKIN, THOMAS ENNIS (PHD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ENNIS
Last Name:ELKIN
Suffix:
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 1:4738 WALNUT GROVE RD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-2524
Mailing Address - Country:US
Mailing Address - Phone:901-767-0762
Mailing Address - Fax:
Practice Address - Street 1:4738 WALNUT GROVE RD
Practice Address - Street 2:SUITE 303
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-2524
Practice Address - Country:US
Practice Address - Phone:901-767-0762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP000597103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN134571OtherBCBS
TN134571OtherBCBS