Basic Information
| Provider Information | |||||||||
| NPI: | 1972997559 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HALLIE B. DURCHSLAG, LTD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 18481 | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND HTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441180481 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8888086625 | ||||||||
| FaxNumber: | 8883887188 | ||||||||
| Practice Location | |||||||||
| Address1: | 3109 MAYFIELD RD | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | CLEVELAND HTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441181726 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2169162070 | ||||||||
| FaxNumber: | 2167955750 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2015 | ||||||||
| LastUpdateDate: | 03/23/2015 | ||||||||
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| AuthorizedOfficialLastName: | DURCHSLAG | ||||||||
| AuthorizedOfficialFirstName: | HALLIE | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2169162070 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | LISW-S | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.