Provider Demographics
NPI:1225144165
Name:SHOFNER, MAYTHA JANE (LCSW)
Entity Type:Individual
Prefix:
First Name:MAYTHA
Middle Name:JANE
Last Name:SHOFNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1032 CANAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550
Mailing Address - Country:US
Mailing Address - Phone:970-690-8944
Mailing Address - Fax:
Practice Address - Street 1:628 MAIN STREET, WINDSOR, CO 80550
Practice Address - Street 2:329 EAST 3RD STREET, LOVELAND, CO 80537
Practice Address - City:WINDSOR, CO
Practice Address - State:CO
Practice Address - Zip Code:80550
Practice Address - Country:US
Practice Address - Phone:970-690-8944
Practice Address - Fax:970-460-0598
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1425101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health