Provider Demographics
NPI:1487008645
Name:WEHLE, SHAUN (PSYD, HSPP, LCAC)
Entity Type:Individual
Prefix:DR
First Name:SHAUN
Middle Name:
Last Name:WEHLE
Suffix:
Gender:M
Credentials:PSYD, HSPP, LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 E 86TH AVE
Mailing Address - Street 2:STE H
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-6236
Mailing Address - Country:US
Mailing Address - Phone:219-323-3311
Mailing Address - Fax:
Practice Address - Street 1:521 E 86TH AVE
Practice Address - Street 2:STE H
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6236
Practice Address - Country:US
Practice Address - Phone:219-323-3311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-14
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
87001121A101YA0400X
IN20042839A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)