Provider Demographics
NPI:1760885438
Name:TANKHA, HALLIE (PHD)
Entity Type:Individual
Prefix:
First Name:HALLIE
Middle Name:
Last Name:TANKHA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:HALLIE
Other - Middle Name:
Other - Last Name:GEORGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:40 HOPEWELL TRL
Mailing Address - Street 2:
Mailing Address - City:MORELAND HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44022-2543
Mailing Address - Country:US
Mailing Address - Phone:440-334-8365
Mailing Address - Fax:
Practice Address - Street 1:24600 CENTER RIDGE RD STE 120
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-5617
Practice Address - Country:US
Practice Address - Phone:216-295-5624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-08
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHP.08419103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical