Randall Kenneth Shively, PHD, LICDC is a
Psychologist - Intellectual & Developmental Disabilities based in Columbus, Ohio. Randall Kenneth Shively is licensed to practice in Ohio (license number 4374) and his current practice location is
2100 Stella Ct, Columbus, Ohio. He can be reached at his office (for appointments etc.) via phone at
(614) 252-8402.
NPI number for Randall Kenneth Shively is 1235608084 and his current mailing address is 2100 Stella Ct, Columbus, Ohio. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1235608084.
Healthcare Provider's Profile
| Full Name | Randall Kenneth Shively |
|---|
| Gender | Male |
|---|
| Speciality | Psychologist - Intellectual & Developmental Disabilities |
|---|
| Location | 2100 Stella Ct, Columbus, Ohio |
|---|
| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
|---|
NPI Data:
- NPI Number: 1235608084
- Provider Enumeration Date: 11/21/2018
- Last Update Date: 04/25/2023
Medical Identifiers
Medical identifiers for Randall Kenneth Shively such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1235608084 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 975850 (Ohio) | Secondary |
| 103TM1800X | Psychologist - Intellectual & Developmental Disabilities | 4374 (Ohio) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Randall Kenneth Shively is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Randall Kenneth Shively, PHD, LICDC
2100 Stella Ct,
Columbus, OH 43215-1011
Ph: (614) 252-8402 | Randall Kenneth Shively, PHD, LICDC
2100 Stella Ct,
Columbus, OH 43215-1011
Ph: (614) 252-8402 |
Reviews and Comments