Provider Demographics
NPI:1033285572
Name:SHAFFER, LISA BROOKE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:BROOKE
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1489 W WARM SPRINGS RD
Mailing Address - Street 2:STE 110
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-7367
Mailing Address - Country:US
Mailing Address - Phone:702-806-8618
Mailing Address - Fax:800-567-4105
Practice Address - Street 1:1489 W WARM SPRINGS RD
Practice Address - Street 2:STE 110
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-7367
Practice Address - Country:US
Practice Address - Phone:702-806-8618
Practice Address - Fax:800-567-4105
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY0498103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100510783Medicaid