| Doctor Name: | RANDALL SHIPLEY |
| NPI Number: | 1154727246 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | SP228 |
| Business Practice Address: | 3601 Big Tree Rd Bellbrook, OH - 453051973 |
| Business Phone Number: | 9378484922 |
| Business Fax Number: | |
| Mailing Address: | 3601 Big Tree Rd, BELLBROOK |
| State: | OH |
| Postal Code: | 453051973 |
| Phone Number: | 9378484922 |
| Fax Number: | |
| NPI Enumeration Date: | 11/17/2014 |
| NPI Last Update Date: | 11/17/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TS0200X |
| License Number: | SP228 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | School |
| Taxonomy Definition: | |