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General NPI Number Information
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NPI Number | 1558841320
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Entity Type | Individual
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Provider Name | SHELLEY A SHAFFER MS, LPCC
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Gender | Female
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Dates
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Enumeration Date | 08/20/2018
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Last Update Date | 10/16/2024
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Provider Practice Location Address
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Address Line | 34079 LAKETOWN RD STE 4
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City | STURGEON LAKE
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State | MN
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Zip | 55783-5006
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Country | US
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Telephone | 218-380-0175
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Fax | 218-485-9105
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Provider Business Mailing Address
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Address Line | PO BOX 463
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City | MOOSE LAKE
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State | MN
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Zip | 55767-0463
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Country | US
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Telephone | 218-380-0175
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 651
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License Number State | MN
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