Provider Demographics
NPI:1578657722
Name:SHEFFER, THAIS RENEE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:THAIS
Middle Name:RENEE
Last Name:SHEFFER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:
Other - Last Name:SHEFFER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:7755 CONIFER DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-4541
Mailing Address - Country:US
Mailing Address - Phone:719-534-3717
Mailing Address - Fax:
Practice Address - Street 1:7755 CONIFER DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-4541
Practice Address - Country:US
Practice Address - Phone:719-534-3717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070233-11041C0700X
COCSW-8741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
345402OtherMANAGED HEALTH NETWORK
NYRA9337Medicare ID - Type Unspecified