Provider Demographics
NPI:1023141587
Name:MCELFRESH, THOMAS ALAN (PSYD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:ALAN
Last Name:MCELFRESH
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7071 CORPORATE WAY
Mailing Address - Street 2:SUITE 108
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-8911
Mailing Address - Country:US
Mailing Address - Phone:937-436-9020
Mailing Address - Fax:
Practice Address - Street 1:7071 CORPORATE WAY
Practice Address - Street 2:SUITE 108
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-8911
Practice Address - Country:US
Practice Address - Phone:937-436-9020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3732103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2523988Medicaid
OH2523988Medicaid