Provider Demographics
NPI:1659574671
Name:SHAFFER, DEEDEE (LPC, LAC, NCC)
Entity Type:Individual
Prefix:
First Name:DEEDEE
Middle Name:
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:LPC, LAC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:695 SADDLEMOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-2029
Mailing Address - Country:US
Mailing Address - Phone:719-243-2184
Mailing Address - Fax:
Practice Address - Street 1:1852 IRWIN DR BLDG 1059
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80913-4176
Practice Address - Country:US
Practice Address - Phone:719-526-8735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
CO5793101YP2500X
CO418101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional