Shively, Randall Kenneth

Shively, Randall Kenneth is an sole proprietor health care provider with primary practice located at 2100 Stella Ct , Columbus OH 43215-1011. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Mental Retardation & Developmental Disabilities. Behavioral Health & Social Service Providers / Mental Retardation & Developmental Disabilities is his primary health care specialty. Shively, Randall Kenneth can be contacted via phone (614) 252-8402.

Contact Information

Primary practice address
2100 Stella Ct Columbus OH 43215-1011
Phone: (614) 252-8402
Fax: (614) 252-5326
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 975850 Ohio
Behavioral Health & Social Service Providers / Mental Retardation & Developmental Disabilities 103TM1800X 4374 Ohio

Profile Details

NPI number 1235608084
LBN Legal business name Shively, Randall Kenneth
Credentials PH.D, LICDC
Entity Individual
Sole proprietor 1 Yes
Enumeration date Nov 21st, 2018
Last updated Apr 25th, 2023 - about 3 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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