Individual provider · Type 1 NPI

Randall Kenneth Shively, PhD, LICDC

Intellectual & Developmental Disabilities Psychologist · Columbus, OH

NPI number 1235608084 Active

Practice location

2100 Stella Ct
Columbus, OH 43215-1011

Call (614) 252-8402 Map

Fax (614) 252-5326

Specialties and licenses

TaxonomyCodeLicense
Addiction (Substance Use Disorder) Counselor 101YA0400X975850 (OH)
Intellectual & Developmental Disabilities Psychologist Primary 103TM1800X4374 (OH)

Intellectual & Developmental Disabilities Psychologist: Definition to come...

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About NPI 1235608084

Randall Kenneth Shively, PhD, LICDC's National Provider Identifier is 1235608084, issued on Nov 21, 2018. The primary taxonomy on file is Intellectual & Developmental Disabilities Psychologist (103TM1800X), and the practice location is in Columbus, OH. The record was last updated on Apr 25, 2023.