Organization
PSYCHOLOGY ASSOCIATES, P.C.
Active
Organization
PSYCHOLOGY ASSOCIATES, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARY W. ELLIOTT PH.D. (PRESIDENT)
(574) 254-1700
Entity
Organization
Contact information
Practice address
314 W CATALPA DR, SUITE E, MISHAWAKA, IN 46545-3194
(574) 254-1700
(574) 254-2930
Mailing address
314 W CATALPA DR, SUITE E, MISHAWAKA, IN 46545-3194
(574) 254-1700
(574) 254-2930
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
57000021A
IN
103T00000X
Psychologist
57000021A
IN
103TC0700X
Clinical Psychologist
57000021A
IN
103TC2200X
Clinical Child & Adolescent Psychologist
57000021A
IN
103TR0400X
Rehabilitation Psychologist
57000021A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100092530A
—
IN
Enumeration date
08/23/2006
Last updated
02/27/2013
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