Healthcare Provider Details

I. General information

NPI: 1871842971
Provider Name (Legal Business Name): AMY M SHAFFER LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2012
Last Update Date: 01/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 PIGEON ROOST RD
RUSH KY
41168-8132
US

IV. Provider business mailing address

5679 STATE ROUTE 207
WURTLAND KY
41144-7439
US

V. Phone/Fax

Practice location:
  • Phone: 606-928-6648
  • Fax: 606-547-4359
Mailing address:
  • Phone: 606-928-6648
  • Fax: 606-547-4359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number103630
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: