Provider Demographics
NPI:1780751669
Name:SHROAD, JOHN MORTON JR (PHD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MORTON
Last Name:SHROAD
Suffix:JR
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 1:14090 MANSFIELD RD
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-9447
Mailing Address - Country:US
Mailing Address - Phone:740-592-6670
Mailing Address - Fax:740-594-2823
Practice Address - Street 1:14090 MANSFIELD RD
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-9447
Practice Address - Country:US
Practice Address - Phone:740-592-6670
Practice Address - Fax:740-594-2823
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2820103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist