Provider Demographics
NPI:1518978071
Name:SHAFFER, COLLEEN ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:ANN
Last Name:SHAFFER
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:PO BOX 1129
Mailing Address - Street 2:
Mailing Address - City:DRIPPING SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78620-1129
Mailing Address - Country:US
Mailing Address - Phone:512-858-1643
Mailing Address - Fax:512-858-1643
Practice Address - Street 1:800 W HIGHWAY 290 STE 600B
Practice Address - Street 2:
Practice Address - City:DRIPPING SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78620-4034
Practice Address - Country:US
Practice Address - Phone:512-858-1643
Practice Address - Fax:512-858-1643
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00S17ROtherBC/BS OF TEXAS
TX00S17ROtherBC/BS OF TEXAS
TX00S49UMedicare ID - Type UnspecifiedHAYS COUNTY