Provider Demographics
NPI:1255857439
Name:SHAFFER, BRIAN KEITH (FT, LPC, NCC, ICAADC)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:KEITH
Last Name:SHAFFER
Suffix:
Gender:M
Credentials:FT, LPC, NCC, ICAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1420
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-5420
Mailing Address - Country:US
Mailing Address - Phone:866-840-5286
Mailing Address - Fax:
Practice Address - Street 1:1953 ASHLEY DR
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-3932
Practice Address - Country:US
Practice Address - Phone:866-840-5286
Practice Address - Fax:866-840-5286
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-18
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI$$$$$$$$$Medicaid