Provider Demographics
NPI:1700292471
Name:SHELLENBERGER, RICHARD II (PHD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:SHELLENBERGER
Suffix:II
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:PO BOX 740
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:OH
Mailing Address - Zip Code:43140-0740
Mailing Address - Country:US
Mailing Address - Phone:740-852-9777
Mailing Address - Fax:
Practice Address - Street 1:1851 STATE ROUTE 56
Practice Address - Street 2:MADISON CORRECTIONAL INSTITUTION
Practice Address - City:LONDON
Practice Address - State:OH
Practice Address - Zip Code:43140-0740
Practice Address - Country:US
Practice Address - Phone:740-852-9777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5275103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5275OtherOHIO PSYCHOLOGY LICENSE NUMBER