Provider Demographics
NPI:1871842971
Name:SHAFFER, AMY M (LPCC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:M
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5679 STATE ROUTE 207
Mailing Address - Street 2:
Mailing Address - City:WURTLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41144-7439
Mailing Address - Country:US
Mailing Address - Phone:606-928-6648
Mailing Address - Fax:606-547-4359
Practice Address - Street 1:2901 PIGEON ROOST RD
Practice Address - Street 2:
Practice Address - City:RUSH
Practice Address - State:KY
Practice Address - Zip Code:41168-8132
Practice Address - Country:US
Practice Address - Phone:606-928-6648
Practice Address - Fax:606-547-4359
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY103630101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30610026Medicaid