Healthcare Provider Details

I. General information

NPI: 1326408360
Provider Name (Legal Business Name): THOMAS GAZLEY PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2016
Last Update Date: 03/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12557 RAVENWOOD DR
CHARDON OH
44024-9009
US

IV. Provider business mailing address

16064 HIGH ST
BURTON OH
44021-9446
US

V. Phone/Fax

Practice location:
  • Phone: 440-285-3568
  • Fax:
Mailing address:
  • Phone: 330-717-5426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4418
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: