Provider Demographics
NPI:1700958246
Name:GORY, ELLIOT LOUIS (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELLIOT
Middle Name:LOUIS
Last Name:GORY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6704 S TERRACE RD
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-4006
Mailing Address - Country:US
Mailing Address - Phone:480-390-5193
Mailing Address - Fax:480-838-0061
Practice Address - Street 1:6704 S TERRACE RD
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-4006
Practice Address - Country:US
Practice Address - Phone:480-390-5193
Practice Address - Fax:480-838-0061
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ605103T00000X, 103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities