Healthcare Provider Details

I. General information

NPI: 1619926615
Provider Name (Legal Business Name): MICHAEL WAYNE SHAFFER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: X

Provider Other Name: MIKE WAYNE SHAFFER LCSW

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 E 38TH ST
MARION IN
46953-4568
US

IV. Provider business mailing address

113 WALNUT DR
GAS CITY IN
46933-1138
US

V. Phone/Fax

Practice location:
  • Phone: 765-674-3321
  • Fax: 765-677-5115
Mailing address:
  • Phone: 765-674-3321
  • Fax: 765-677-5115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number20854
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: