Healthcare Provider Details

I. General information

NPI: 1689509523
Provider Name (Legal Business Name): MARISSA SHAFFER MA, LPC, R-DMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARS SHAFFER MA, LPC, R-DMT

II. Dates (important events)

Enumeration Date: 06/13/2026
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2130 MOUNTAIN VIEW AVE STE 202
LONGMONT CO
80501-3177
US

IV. Provider business mailing address

2535 SUNSET DR APT 258
LONGMONT CO
80501-7530
US

V. Phone/Fax

Practice location:
  • Phone: 970-599-1159
  • Fax:
Mailing address:
  • Phone: 831-325-6452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0023922
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: