Provider Demographics
NPI:1447540968
Name:ELDER, DEREK HARTLEY (LPC)
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:HARTLEY
Last Name:ELDER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4838 CAMAS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-5566
Mailing Address - Country:US
Mailing Address - Phone:210-326-4663
Mailing Address - Fax:
Practice Address - Street 1:16607 BLANCO RD
Practice Address - Street 2:SUITE # 502
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-1913
Practice Address - Country:US
Practice Address - Phone:210-326-4663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-18
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63638101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional