Provider Demographics
NPI:1710974035
Name:ELLIOTT & ASSOCIATES INC
Entity Type:Organization
Organization Name:ELLIOTT & ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:J
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:419-885-1910
Mailing Address - Street 1:5600 MONROE ST
Mailing Address - Street 2:STE 201
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-2731
Mailing Address - Country:US
Mailing Address - Phone:419-885-1910
Mailing Address - Fax:419-885-5060
Practice Address - Street 1:5600 MONROE ST
Practice Address - Street 2:STE 201
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2731
Practice Address - Country:US
Practice Address - Phone:419-885-1910
Practice Address - Fax:419-885-5060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty