Provider Demographics
NPI:1962615401
Name:MCELWAIN, DOUGLAS CARTER (PHD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:CARTER
Last Name:MCELWAIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5121 RANSTEAD CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-2585
Mailing Address - Country:US
Mailing Address - Phone:614-747-0435
Mailing Address - Fax:614-263-2115
Practice Address - Street 1:1660 NW PROFESSIONAL PLZ
Practice Address - Street 2:SUITE F
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-3854
Practice Address - Country:US
Practice Address - Phone:614-263-2113
Practice Address - Fax:614-263-2115
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3583103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities