Provider Demographics
NPI:1457486961
Name:ADAMS, ELIZABETH CAROLINE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:CAROLINE
Last Name:ADAMS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1178 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:VAN WERT
Mailing Address - State:OH
Mailing Address - Zip Code:45891-2461
Mailing Address - Country:US
Mailing Address - Phone:419-238-6251
Mailing Address - Fax:419-238-3002
Practice Address - Street 1:1178 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:VAN WERT
Practice Address - State:OH
Practice Address - Zip Code:45891-2461
Practice Address - Country:US
Practice Address - Phone:419-238-6251
Practice Address - Fax:419-238-3002
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6301103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2733135Medicaid
OH2733135Medicaid