Provider Demographics
NPI:1366685315
Name:ELDER, THADDEUS (LPC)
Entity type:Individual
Prefix:
First Name:THADDEUS
Middle Name:
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 1:100 RIDGEWAY ST STE 1
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901-7155
Mailing Address - Country:US
Mailing Address - Phone:501-545-6420
Mailing Address - Fax:501-623-2266
Practice Address - Street 1:100 RIDGEWAY ST STE 1
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-7155
Practice Address - Country:US
Practice Address - Phone:501-545-6420
Practice Address - Fax:501-623-2266
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-07
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1312117101Y00000X
ARA1004045101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR116399726Medicaid