MEDICARE: ALYSSA SHAFFER MA, LAC, NCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LPC-23354	AZ

General Provider Information

NPI Number	:	1649933680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA SHAFFER MA, LAC, NCC

Provider Business Mailing Address
First Line	:	16648 N 19TH PL
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85022-6232
Country	:	US
Telephone Number	:	602-819-0376
Fax Number	:

Provider Business Practice Location Address
First Line	:	16648 N 19TH PL
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85022-6232
Country	:	US
Telephone Number	:	602-819-0376
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2021
Last Update Date	:	03/16/2026

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