Provider Demographics
NPI:1184732711
Name:RASULIS, RICHARD G JR (PHD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:G
Last Name:RASULIS
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1201 E 9TH ST BLDG 241A-108
Mailing Address - Street 2:(181B)
Mailing Address - City:BONHAM
Mailing Address - State:TX
Mailing Address - Zip Code:75418-4059
Mailing Address - Country:US
Mailing Address - Phone:214-559-2171
Mailing Address - Fax:214-559-2118
Practice Address - Street 1:1201 E 9TH ST BLDG 241A-108
Practice Address - Street 2:(181B)
Practice Address - City:BONHAM
Practice Address - State:TX
Practice Address - Zip Code:75418-4059
Practice Address - Country:US
Practice Address - Phone:214-559-2171
Practice Address - Fax:214-559-2118
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31555103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical