Provider Demographics
NPI:1114979341
Name:SHURELL, RICHARD J (PHD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:SHURELL
Suffix:
Gender:M
Credentials:PHD
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4833 DARROW ROAD SUITE 101
Mailing Address - Street 2:WESTERN RESERVE PSYCHOLOGICAL ASSOCIATES INC
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-1411
Mailing Address - Country:US
Mailing Address - Phone:330-650-5338
Mailing Address - Fax:330-342-3837
Practice Address - Street 1:4833 DARROW ROAD SUITE 101
Practice Address - Street 2:WESTERN RESERVE PSYCHOLOGICAL ASSOCIATES INC
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-1411
Practice Address - Country:US
Practice Address - Phone:330-650-5338
Practice Address - Fax:330-342-3837
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH3027103T00000X, 103TB0200X, 103TC0700X, 103TE1100X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & Sports
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Provider Identifiers
StateIdentifier IDID TypeIssuer
R80375Medicare UPIN