Provider Demographics
NPI:1245409689
Name:SHAFER-LIND, ELLEN KATHERINE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:KATHERINE
Last Name:SHAFER-LIND
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MRS
Other - First Name:ELLEN
Other - Middle Name:KATHERINE
Other - Last Name:SHAFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:2222 2ND AVE
Mailing Address - Street 2:SUITE 801 BOX 8
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-5354
Mailing Address - Country:US
Mailing Address - Phone:308-999-9500
Mailing Address - Fax:
Practice Address - Street 1:2222 2ND AVE
Practice Address - Street 2:SUITE 801 BOX 8
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-5354
Practice Address - Country:US
Practice Address - Phone:308-999-9500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-28
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1035101YM0800X
NE5481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health