IndividualActive
Randall Shively, PH.D, LICDC
NPI 1235608084 · Intellectual & Developmental Disabilities Psychologist · Columbus, OH
Provider details
- NPI number
- 1235608084
- Entity type
- Individual
- Primary specialty
- Intellectual & Developmental Disabilities PsychologistBehavioral Health & Social Service Providers
- Credential
- PH.D, LICDC
- Sex
- Male
- Sole proprietor
- Yes
- License
- 975850 (OH)
Specialties & taxonomies
Behavioral Health & Social Service Providers
Behavioral Health & Social Service Providers
Practice location
2100 Stella Ct
Columbus, OH 43215-1011
Phone: (614) 252-8402
Fax: (614) 252-5326
Approximate (ZIP-level) locationGet directions
Mailing address
2100 Stella Ct
Columbus, OH 43215-1011
Registry dates
- Enumerated
- 2018-11-21
- Last updated
- 2023-04-25
- Certified
- 2023-04-25
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.