Provider Demographics
NPI:1760692305
Name:ATCHLEY, SHAWN R
Entity Type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:R
Last Name:ATCHLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:999 LILA AVE
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150-1617
Mailing Address - Country:US
Mailing Address - Phone:513-831-1617
Mailing Address - Fax:
Practice Address - Street 1:4906 CHALET DR
Practice Address - Street 2:UNIT 5
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45217-1457
Practice Address - Country:US
Practice Address - Phone:513-641-5815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI0010070101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health