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General NPI Number Information
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NPI Number | 1881550796
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Entity Type | Individual
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Provider Name | LOGAN ALEXANDER SHAFFER LPC-MHSP
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Gender | Male
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Dates
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Enumeration Date | 01/05/2026
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Last Update Date | 01/05/2026
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Provider Practice Location Address
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Address Line | 1570 WAVERLY RD
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City | KINGSPORT
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State | TN
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Zip | 37664-2523
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Country | US
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Telephone | 423-224-1353
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Fax |
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Provider Business Mailing Address
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Address Line | 1445 BRIDWELL ST
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City | KINGSPORT
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State | TN
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Zip | 37664-3307
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Country | US
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Telephone | 423-579-8047
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 8472
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License Number State | TN
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