Provider Demographics
NPI:1851869556
Name:SHAFFER, KAYLA K (LPC)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:K
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4964 BELMONT AVE STE B
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44505-1001
Mailing Address - Country:US
Mailing Address - Phone:330-539-3200
Mailing Address - Fax:330-529-5241
Practice Address - Street 1:4964 BELMONT AVE STE B
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44505-1001
Practice Address - Country:US
Practice Address - Phone:330-539-3200
Practice Address - Fax:330-529-5241
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-12
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1901526-TRNE101Y00000X
OHLPN.136876.MEDS164W00000X
OHCDCA.169967251S00000X
OHC.2103660101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0332221Medicaid