Provider Demographics
NPI:1104987874
Name:MCELROY, GEORGE BOWDEN IV (MED)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:BOWDEN
Last Name:MCELROY
Suffix:IV
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3104 S ELM PL STE G
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-7949
Mailing Address - Country:US
Mailing Address - Phone:918-346-3665
Mailing Address - Fax:918-948-7018
Practice Address - Street 1:3104 S ELM PL STE G
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-7949
Practice Address - Country:US
Practice Address - Phone:918-346-3665
Practice Address - Fax:918-948-7018
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15919101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional