Healthcare Provider Details

I. General information

NPI: 1043830607
Provider Name (Legal Business Name): SHUPING LIN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2020
Last Update Date: 04/23/2020
Certification Date: 04/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

987 S HIGH ST
COLUMBUS OH
43206-2527
US

IV. Provider business mailing address

2764 DALE AVE
BEXLEY OH
43209-1811
US

V. Phone/Fax

Practice location:
  • Phone: 614-468-8184
  • Fax:
Mailing address:
  • Phone: 614-966-1866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number017918-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TE1100X
TaxonomyExercise & Sports Psychologist
License Number017918-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: