Provider Demographics
NPI:1114658986
Name:SHI, MOLIN (PHD)
Entity Type:Individual
Prefix:
First Name:MOLIN
Middle Name:
Last Name:SHI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 E MARKET ST APT 510
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46204-2867
Mailing Address - Country:US
Mailing Address - Phone:585-683-4616
Mailing Address - Fax:
Practice Address - Street 1:362 W 15TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-2266
Practice Address - Country:US
Practice Address - Phone:317-963-7300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20043550A103TC0700X
TX39456103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical