Provider Demographics
NPI:1578396826
Name:MCELFRESH, MITCHELL (MGC, CGC)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:
Last Name:MCELFRESH
Suffix:
Gender:M
Credentials:MGC, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:LA
Mailing Address - Zip Code:70121-4227
Mailing Address - Country:US
Mailing Address - Phone:504-703-7608
Mailing Address - Fax:
Practice Address - Street 1:1515 RIVER RD
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:LA
Practice Address - Zip Code:70121-4227
Practice Address - Country:US
Practice Address - Phone:504-703-7608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA343654170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS