Provider Demographics
NPI:1639285232
Name:PSYCHOLOGY ASSOCIATES, P.C.
Entity type:Organization
Organization Name:PSYCHOLOGY ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:W
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:574-254-1700
Mailing Address - Street 1:314 W CATALPA DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-3194
Mailing Address - Country:US
Mailing Address - Phone:574-254-1700
Mailing Address - Fax:574-254-2930
Practice Address - Street 1:314 W CATALPA DR
Practice Address - Street 2:SUITE E
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-3194
Practice Address - Country:US
Practice Address - Phone:574-254-1700
Practice Address - Fax:574-254-2930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN57000021A103TC0700X, 103TC2200X, 103T00000X, 103TR0400X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100092530AMedicaid
IN100092530AMedicaid