Provider Demographics
NPI:1922430917
Name:HALSTEAD, GARY A (PHD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:A
Last Name:HALSTEAD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:OH
Mailing Address - Zip Code:44017-1780
Mailing Address - Country:US
Mailing Address - Phone:440-234-2231
Mailing Address - Fax:
Practice Address - Street 1:505 FRONT ST
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:OH
Practice Address - Zip Code:44017-1780
Practice Address - Country:US
Practice Address - Phone:440-234-2231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-01
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral