Provider Demographics
NPI:1962215400
Name:ELLIOTT, TORY SKYE (PHD)
Entity type:Individual
Prefix:
First Name:TORY
Middle Name:SKYE
Last Name:ELLIOTT
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:TORY
Other - Middle Name:SKYE
Other - Last Name:MERTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:3254 S KINNICKINNIC AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53207-3120
Mailing Address - Country:US
Mailing Address - Phone:708-557-2108
Mailing Address - Fax:
Practice Address - Street 1:5007 S HOWELL AVE STE 350
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53207-6159
Practice Address - Country:US
Practice Address - Phone:708-557-2108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-29
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
WI5335-57103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist