Provider Demographics
NPI:1558841320
Name:SHAFFER, SHELLEY A (MS, LPCC)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:A
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:MS, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4619 KASPER RD
Mailing Address - Street 2:
Mailing Address - City:MOOSE LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55767-9203
Mailing Address - Country:US
Mailing Address - Phone:507-381-3060
Mailing Address - Fax:
Practice Address - Street 1:4619 KASPER RD
Practice Address - Street 2:
Practice Address - City:MOOSE LAKE
Practice Address - State:MN
Practice Address - Zip Code:55767-9203
Practice Address - Country:US
Practice Address - Phone:507-381-3060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN00651101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health