Healthcare Provider Details

I. General information

NPI: 1790590701
Provider Name (Legal Business Name): SHAWN SCHAEFFER LCSW, MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2025
Last Update Date: 02/08/2025
Certification Date: 02/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9263 MCKEE RD
IRVINE KY
40336-9240
US

IV. Provider business mailing address

9263 MCKEE RD
IRVINE KY
40336-9240
US

V. Phone/Fax

Practice location:
  • Phone: 606-614-8384
  • Fax:
Mailing address:
  • Phone: 606-614-3884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number259383
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: