Provider Demographics
NPI:1861909905
Name:MCELVAINE, GREGORY RYAN (LCPC-C)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:RYAN
Last Name:MCELVAINE
Suffix:
Gender:M
Credentials:LCPC-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:557 HAMMOND ST
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-4511
Mailing Address - Country:US
Mailing Address - Phone:207-973-0505
Mailing Address - Fax:207-992-2175
Practice Address - Street 1:557 HAMMOND ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-4511
Practice Address - Country:US
Practice Address - Phone:207-973-0505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL4984101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional