Provider Demographics
NPI:1558473611
Name:SHAFFER, MICHAEL H (LCSW MFT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:H
Last Name:SHAFFER
Suffix:
Gender:M
Credentials:LCSW MFT
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 1381
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93275
Mailing Address - Country:US
Mailing Address - Phone:559-684-8066
Mailing Address - Fax:559-684-1152
Practice Address - Street 1:5431 W HILLSDALE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291
Practice Address - Country:US
Practice Address - Phone:559-684-8066
Practice Address - Fax:559-684-1152
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3472LCSW1041C0700X
CA5570MFC106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ79360ZMedicare PIN
R22514Medicare UPIN