Provider Demographics
NPI:1891974952
Name:SCHAFFER, EVELYN I (MFT)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:I
Last Name:SCHAFFER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1729 TULLY RD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-4082
Mailing Address - Country:US
Mailing Address - Phone:209-571-6050
Mailing Address - Fax:209-571-6059
Practice Address - Street 1:1729 TULLY RD
Practice Address - Street 2:SUITE 8
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4082
Practice Address - Country:US
Practice Address - Phone:209-571-6050
Practice Address - Fax:209-571-6059
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC27494106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist