Provider Demographics
NPI:1528264108
Name:KING, SHAWN DAVID (PHD, LISWS)
Entity type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:DAVID
Last Name:KING
Suffix:
Gender:M
Credentials:PHD, LISWS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 176
Mailing Address - Street 2:
Mailing Address - City:CHAUNCEY
Mailing Address - State:OH
Mailing Address - Zip Code:45719-0176
Mailing Address - Country:US
Mailing Address - Phone:740-856-8767
Mailing Address - Fax:740-589-5701
Practice Address - Street 1:53 MAY AVENUE
Practice Address - Street 2:
Practice Address - City:CHAUNCEY
Practice Address - State:OH
Practice Address - Zip Code:45719
Practice Address - Country:US
Practice Address - Phone:740-856-8767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.1101401-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH051630OtherMEDICARE PTAN