Provider Demographics
NPI:1619429065
Name:SHAFFER COUNSELING SERVICES, PLLC
Entity Type:Organization
Organization Name:SHAFFER COUNSELING SERVICES, PLLC
Other - Org Name:PAM SHAFFER COUNSELING, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAFFER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMHC, CDP
Authorized Official - Phone:425-772-4353
Mailing Address - Street 1:833 NE 95TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-2129
Mailing Address - Country:US
Mailing Address - Phone:425-772-4353
Mailing Address - Fax:
Practice Address - Street 1:600 N 36TH ST
Practice Address - Street 2:SUITE 424
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8697
Practice Address - Country:US
Practice Address - Phone:425-772-4353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-02
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60518618251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1427331057Medicaid