Basic Information
Provider Information
NPI: 1558323279
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LINDSEY
FirstName: SHELLEY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.ED
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 634167
Address2:  
City: CINCINNATI
State: OH
PostalCode: 452630001
CountryCode: US
TelephoneNumber: 5138911006
FaxNumber: 5137931032
Practice Location
Address1: 1490 UNIVERSITY BLVD
Address2:  
City: HAMILTON
State: OH
PostalCode: 450113305
CountryCode: US
TelephoneNumber: 5138817189
FaxNumber: 5138817188
Other Information
ProviderEnumerationDate: 04/06/2006
LastUpdateDate: 01/13/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YP2500XE 0003071OHY Behavioral Health & Social Service ProvidersCounselorProfessional

No ID Information.


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