Provider Demographics
NPI:1558356550
Name:HALAS, RICHARD CARL (MA)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:CARL
Last Name:HALAS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26300 EUCLID AVE
Mailing Address - Street 2:#716
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44132-3708
Mailing Address - Country:US
Mailing Address - Phone:216-289-8930
Mailing Address - Fax:216-289-8934
Practice Address - Street 1:26300 EUCLID AVE
Practice Address - Street 2:#716
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44132-3708
Practice Address - Country:US
Practice Address - Phone:216-289-8930
Practice Address - Fax:216-289-8934
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-15
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1667103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCP02021Medicare ID - Type Unspecified