Healthcare Provider Details

I. General information

NPI: 1851869556
Provider Name (Legal Business Name): KAYLA K SHAFFER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2018
Last Update Date: 06/21/2024
Certification Date: 05/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1716 NORTH RD SE
WARREN OH
44484-2907
US

IV. Provider business mailing address

4964 BELMONT AVE STE B
YOUNGSTOWN OH
44505-1001
US

V. Phone/Fax

Practice location:
  • Phone: 330-539-3200
  • Fax: 330-529-5241
Mailing address:
  • Phone: 330-539-3200
  • Fax: 330-529-5241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC.1901526-TRNE
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.2103660
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN.136876.MEDS
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberCDCA.169967
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: