Provider Demographics
NPI:1831926351
Name:SHIPE, ZACHARY IAN
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:IAN
Last Name:SHIPE
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 1:1271 CRESCENT HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-6455
Mailing Address - Country:US
Mailing Address - Phone:614-355-0128
Mailing Address - Fax:
Practice Address - Street 1:1271 CRESCENT HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-6455
Practice Address - Country:US
Practice Address - Phone:614-355-0128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.183127101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)