Provider Demographics
NPI:1922529684
Name:GRAY, ELIZABETH P (PHD)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:P
Last Name:GRAY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MISS
Other - First Name:ELIZABETH
Other - Middle Name:P
Other - Last Name:GARLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1074 AVON ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44310-1360
Mailing Address - Country:US
Mailing Address - Phone:207-299-2785
Mailing Address - Fax:
Practice Address - Street 1:900 MULL AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313-7502
Practice Address - Country:US
Practice Address - Phone:800-621-5207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-03
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OHP.08226103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program