Provider Demographics
NPI:1225763501
Name:SHAFFER, CHLOE N (LPC, NCC)
Entity Type:Individual
Prefix:
First Name:CHLOE
Middle Name:N
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2539
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40702-2539
Mailing Address - Country:US
Mailing Address - Phone:217-412-4030
Mailing Address - Fax:
Practice Address - Street 1:1 SENECA ST FL 24
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-2734
Practice Address - Country:US
Practice Address - Phone:217-412-4030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-20
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN88001796A101YM0800X
IL178.017873101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health