Provider Demographics
NPI:1528281565
Name:MAGGARD, ELMER C (PHD)
Entity type:Individual
Prefix:DR
First Name:ELMER
Middle Name:C
Last Name:MAGGARD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 W JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-4336
Mailing Address - Country:US
Mailing Address - Phone:859-489-7384
Mailing Address - Fax:
Practice Address - Street 1:2500 HOLT RD
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-8661
Practice Address - Country:US
Practice Address - Phone:869-489-7384
Practice Address - Fax:270-558-3257
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY129645103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3009502Medicare ID - Type UnspecifiedCLINICAL PSYCHOLOGIST