Individual
MR. GARY W. ELLIOTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
314 W CATALPA, SUITE E, MISHAWAKA, IN 46545
(574) 254-1700
(574) 254-2930
Mailing address
314 W CATALPA, SUITE E, MISHAWAKA, IN 46545
(574) 254-1700
(574) 254-2930
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
20010470A
IN
103TC0700X
Clinical Psychologist
20010470A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1844001
OAKLAWN PSYCHIATRIC CENTE
IN
Enumeration date
10/20/2005
Last updated
01/10/2008
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