Provider Demographics
NPI:1902881550
Name:ELWOOD, JOHN V (PSYD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:V
Last Name:ELWOOD
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:PO BOX 938
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76540-0938
Mailing Address - Country:US
Mailing Address - Phone:254-634-6999
Mailing Address - Fax:254-200-4090
Practice Address - Street 1:1717 SW H K DODGEN LOOP
Practice Address - Street 2:SUITE 110
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-1838
Practice Address - Country:US
Practice Address - Phone:254-791-8900
Practice Address - Fax:254-200-4090
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-07
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22427103T00000X
TX6090103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX742281271OtherSUPERIOR HEALTH CHIP
TX742281271OtherTRICARE
TX00BY20OtherBCBS
TX91851OtherSCOTT & WHITE
TX032356001Medicaid
TX91851OtherSCOTT & WHITE
TX00BY20OtherBCBS