Provider Demographics
NPI:1982775375
Name:ELLIOTT, CHRISTINE (PHD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 VILLAGE WAY STE 1A
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-5116
Mailing Address - Country:US
Mailing Address - Phone:330-655-2674
Mailing Address - Fax:330-650-2609
Practice Address - Street 1:72 VILLAGE WAY STE 1A
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-5116
Practice Address - Country:US
Practice Address - Phone:330-655-2674
Practice Address - Fax:330-650-2609
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4735103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical