Provider Demographics
NPI:1750449492
Name:SHAFER, MICHEAL EVANS (MS)
Entity Type:Individual
Prefix:MR
First Name:MICHEAL
Middle Name:EVANS
Last Name:SHAFER
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:MICHEAL
Other - Middle Name:EVANS
Other - Last Name:SCHAFER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1200 E MICHIGAN AVE
Mailing Address - Street 2:SUITE 630
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-1800
Mailing Address - Country:US
Mailing Address - Phone:517-364-5130
Mailing Address - Fax:517-364-5133
Practice Address - Street 1:1200 E MICHIGAN AVE
Practice Address - Street 2:SUITE 630
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-1800
Practice Address - Country:US
Practice Address - Phone:517-362-5130
Practice Address - Fax:517-364-5133
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013318103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical