Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 3027 | OH |
Y | 103T00000X | Psychologist | 3027 | OH |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 3027 | OH |
N | 103G00000X | Clinical Psychologist | 3027 | OH |
N | 103TC0700X | Clinical Psychologist | 3027 | OH |
N | 103TE1100X | Exercise & Sports Psychologist | 3027 | OH |
N | 103TF0200X | Forensic Psychologist | 3027 | OH |
NPI | 1114979341 |
---|---|
Provider Name | Richard J Shurell |
First Address | Stow, OH 44224-1411 |
Second Address | Stow, OH 44224-1411 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2006 |
Last Update Date | 14/12/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
R80375 | (02) |