RANDALL KENNETH SHIVELY PH.D LICDC NPI 1235608084

NPI Information

NPI: 1235608084
Provider Name: RANDALL KENNETH SHIVELY, PH.D, LICDC
Classification: Psychologist - 103TM1800X
Entity Type: Individual

Specialization: Intellectual and Developmental Disabilities

PECOS Registration: Yes

Address:
2100 STELLA CT
COLUMBUS, OH
ZIP 43215
Phone: (614) 252-8402
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Randall Kenneth Shively, PH.D, LICDC is an intellectual and developmental disabilities in Columbus, OH. Randall Kenneth Shively, PH.D, LICDC NPI is 1235608084. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

2100 STELLA CT
COLUMBUS, OH
ZIP 43215-011
Phone: (614) 252-8402
Fax: (614) 252-5326

The NPI 1235608084 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment.

The enumeration date for this NPI number is 11/21/2018 and was last updated on 4/25/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	101YA0400X	Counselor	Addiction (Substance Use Disorder)	975850	OHIO	No
2	103TM1800X	Psychologist	Intellectual and Developmental Disabilities	4374	OHIO	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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