Shetler, Jay R

Shetler, Jay R is an individual health care provider with primary practice located at 1930 W Lincoln Ave , Goshen IN 46526-5907. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Shetler, Jay R can be contacted via phone (574) 534-2161.

Contact Information

Primary practice address
1930 W Lincoln Ave Goshen IN 46526-5907
Phone: (574) 534-2161
Fax: (574) 534-3887
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X 20041401A Indiana

Profile Details

NPI number 1962429654
LBN Legal business name Shetler, Jay R
Credentials PSYD, HSPP
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 17th, 2006
Last updated Oct 2nd, 2008 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1962429654 NPPES
Indiana MEDICAID 200270630A

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