Individual
MR. JAY R SHETLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSYD, HSPP
Contact information
Practice address
1930 W LINCOLN AVE, GOSHEN, IN 46526-5907
(574) 534-2161
(574) 534-3887
Mailing address
1930 W LINCOLN AVE, GOSHEN, IN 46526-5907
(574) 534-2161
(574) 534-3887
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
20041401A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200270630A
—
IN
Enumeration date
07/17/2006
Last updated
10/02/2008
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