Provider Demographics
NPI:1790196442
Name:SHAFFER, CHELLIE KINGSLEY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CHELLIE
Middle Name:KINGSLEY
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4231 LA CONCETTA DR
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-1920
Mailing Address - Country:US
Mailing Address - Phone:949-943-0392
Mailing Address - Fax:
Practice Address - Street 1:4231 LA CONCETTA DR
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-1920
Practice Address - Country:US
Practice Address - Phone:949-943-0392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-15
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20015103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist