Healthcare Provider Details

I. General information

NPI: 1417440173
Provider Name (Legal Business Name): PAUL MICHAEL SHAWLER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2018
Last Update Date: 01/05/2022
Certification Date: 01/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3412 S ILLINOIS AVE
CARBONDALE IL
62903-8362
US

IV. Provider business mailing address

1030 N SPRINGER ST
CARBONDALE IL
62901-1290
US

V. Phone/Fax

Practice location:
  • Phone: 618-539-2155
  • Fax: 618-457-8844
Mailing address:
  • Phone: 405-227-5437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number071.010669
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number071.010669
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1311
License Number StateOK
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071.010669
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number1311
License Number StateOK
# 6
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number071.010669
License Number StateIL
# 7
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number071.010669
License Number StateIL
# 8
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number1311
License Number StateOK
# 9
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number1311
License Number StateOK
# 10
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number071.010669
License Number StateIL
# 11
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State
# 12
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number071.010669
License Number StateIL
# 13
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number071.010669
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: