Provider Demographics
| NPI: | 1518927748 |
|---|---|
| Name: | SCHELL, JOHN S (PHD) |
| Entity Type: | Individual |
| Prefix: | |
| First Name: | JOHN |
| Middle Name: | S |
| Last Name: | SCHELL |
| Suffix: | |
| Gender: | M |
| 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: | 4833 DARROW ROAD SUITE 101 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | STOW |
| Mailing Address - State: | OH |
| Mailing Address - Zip Code: | 44224-1411 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 330-650-5338 |
| Mailing Address - Fax: | 330-342-3837 |
| Practice Address - Street 1: | 4833 DARROW ROAD SUITE 101 |
| Practice Address - Street 2: | |
| Practice Address - City: | STOW |
| Practice Address - State: | OH |
| Practice Address - Zip Code: | 44224-1411 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 330-650-5338 |
| Practice Address - Fax: | 330-342-3837 |
| Is Sole Proprietor?: | No |
| Enumeration Date: | 2006-03-23 |
| Last Update Date: | 2010-12-21 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| OH | 5712 | 103TC0700X, 103T00000X, 106H00000X, 103TA0400X, 103TA0700X, 103TC2200X, 103TB0200X, 103TE1100X, 103TF0000X, 103TF0200X, 103TP2701X, 103TH0100X, 103TM1800X, 103TH0004X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization |
|---|---|---|---|---|
| Yes | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | |
| No | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical |
| No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | |
| No | 103TA0400X | Behavioral Health & Social Service Providers | Psychologist | Addiction (Substance Use Disorder) |
| No | 103TA0700X | Behavioral Health & Social Service Providers | Psychologist | Adult Development & Aging |
| No | 103TC2200X | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent |
| No | 103TB0200X | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral |
| No | 103TE1100X | Behavioral Health & Social Service Providers | Psychologist | Exercise & Sports |
| No | 103TF0000X | Behavioral Health & Social Service Providers | Psychologist | Family |
| No | 103TF0200X | Behavioral Health & Social Service Providers | Psychologist | Forensic |
| No | 103TP2701X | Behavioral Health & Social Service Providers | Psychologist | Group Psychotherapy |
| No | 103TH0100X | Behavioral Health & Social Service Providers | Psychologist | Health Service |
| No | 103TM1800X | Behavioral Health & Social Service Providers | Psychologist | Intellectual & Developmental Disabilities |
| No | 103TH0004X | Behavioral Health & Social Service Providers | Psychologist | Health |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| CP24961 | Medicare ID - Type Unspecified | ||
| OH | CP34631 | Medicare PIN | |
| F29745 | Medicare UPIN |
