MEDICARE: DR. SHAUN WEHLE PSY.D., HSPP, LCAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	87001121A
2	103TC0700X	Clinical Psychologist	20042839A	IN

General Provider Information

NPI Number	:	1487008645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHAUN WEHLE PSY.D., HSPP, LCAC

Provider Business Mailing Address
First Line	:	521 E 86TH AVE
Second Line	:	STE H
City	:	MERRILLVILLE
State	:	IN
Zip	:	46410-6236
Country	:	US
Telephone Number	:	219-323-3311
Fax Number	:

Provider Business Practice Location Address
First Line	:	521 E 86TH AVE
Second Line	:	STE H
City	:	MERRILLVILLE
State	:	IN
Zip	:	46410-6236
Country	:	US
Telephone Number	:	219-323-3311
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2016
Last Update Date	:	07/07/2020

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