Provider Demographics
NPI:1437413192
Name:SCHAFFNER, THERESE DIANE (LAC, LPC-S, NCC)
Entity Type:Individual
Prefix:
First Name:THERESE
Middle Name:DIANE
Last Name:SCHAFFNER
Suffix:
Gender:F
Credentials:LAC, LPC-S, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 ROSS RD
Mailing Address - Street 2:
Mailing Address - City:HAUGHTON
Mailing Address - State:LA
Mailing Address - Zip Code:71037-8288
Mailing Address - Country:US
Mailing Address - Phone:318-210-1539
Mailing Address - Fax:318-584-7133
Practice Address - Street 1:3821 SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-1033
Practice Address - Country:US
Practice Address - Phone:318-946-8157
Practice Address - Fax:318-216-5868
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-27
Last Update Date:2023-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4907101YP2500X
LA1454101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA3353458Medicaid