Gary W. Elliott, PHD

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

20010470A Issued in IN

Practice address

314 W Catalpa
Suite E
Mishawaka, IN 46545

Phone

(574) 254-1700

Fax

(574) 254-2930

NPI assigned

Oct 20, 2005

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1129766400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1199923200000",
    "number": "1518956648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "314 W CATALPA",
            "address_2": "SUITE E",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "46545",
            "telephone_number": "574-254-1700",
            "fax_number": "574-254-2930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "314 W CATALPA",
            "address_2": "SUITE E",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "46545",
            "telephone_number": "574-254-1700",
            "fax_number": "574-254-2930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIOTT",
        "first_name": "GARY",
        "middle_name": "W.",
        "name_prefix": "Mr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-10-20",
        "last_updated": "2008-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "IN",
            "license": "20010470A",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IN",
            "license": "20010470A",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OAKLAWN PSYCHIATRIC CENTE",
            "identifier": "1844001",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Caitlin Elspeth Edward, FNP-BC
• Chad Robert Edwards, PH.D.
• Morgan K Eichorst, PHD
• Amanda Einselen, LMHC
• Elek LLC
• Rita Elliott, M.A., CCC-SLP
• Kathleen Dunlevy Ellis, PA-C
• Emily Elston, PA-C
• Francis Engel, DO
• Michael Englert, M.D.

• Clinical Neuropsychologist in Mishawaka, IN
• Providers in Mishawaka, IN by specialty
• Clinical Neuropsychologist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.