Healthcare Provider Details

I. General information

NPI: 1922529684
Provider Name (Legal Business Name): ELIZABETH P GRAY PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS ELIZABETH P GARLAND

II. Dates (important events)

Enumeration Date: 07/03/2017
Last Update Date: 04/18/2022
Certification Date: 04/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 MULL AVE
AKRON OH
44313-7502
US

IV. Provider business mailing address

1074 AVON ST
AKRON OH
44310-1360
US

V. Phone/Fax

Practice location:
  • Phone: 800-621-5207
  • Fax:
Mailing address:
  • Phone: 207-299-2785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberP.08226
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: