Provider Demographics
NPI:1972718542
Name:ALISHIO, KIP CHARLES (PHD)
Entity Type:Individual
Prefix:DR
First Name:KIP
Middle Name:CHARLES
Last Name:ALISHIO
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 1:195 HEALTH SERVICES BUILDING
Mailing Address - Street 2:MIAMI UNIVERSITY
Mailing Address - City:OXFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45056
Mailing Address - Country:US
Mailing Address - Phone:513-529-4634
Mailing Address - Fax:513-529-2975
Practice Address - Street 1:195 HEALTH SERVICES BUILDING
Practice Address - Street 2:MIAMI UNIVERSITY
Practice Address - City:OXFORD
Practice Address - State:OH
Practice Address - Zip Code:45056
Practice Address - Country:US
Practice Address - Phone:513-529-4634
Practice Address - Fax:513-529-2975
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3776103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical