Provider Demographics
NPI:1720782691
Name:SHEA, HALEY ALYSSA (PHD)
Entity Type:Individual
Prefix:DR
First Name:HALEY
Middle Name:ALYSSA
Last Name:SHEA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 DELTA AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45226-2033
Mailing Address - Country:US
Mailing Address - Phone:260-519-5042
Mailing Address - Fax:
Practice Address - Street 1:4450 CARVER WOODS DR
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-5527
Practice Address - Country:US
Practice Address - Phone:513-984-9940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHP.08172103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling