Provider Demographics
NPI:1700228103
Name:SHAFFER, KELLY JO (LPC, LAC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:JO
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:LPC, LAC
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:JO
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, LAC
Mailing Address - Street 1:2255 S ONEIDA ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224-2522
Mailing Address - Country:US
Mailing Address - Phone:303-360-6276
Mailing Address - Fax:
Practice Address - Street 1:3515 S DELAWARE ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80110-3529
Practice Address - Country:US
Practice Address - Phone:303-360-6276
Practice Address - Fax:303-762-1583
Is Sole Proprietor?:No
Enumeration Date:2013-07-25
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACD.0000869101YA0400X
COLPC.0012897101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)