MEDICARE: DEEDEE SHAFFER LPC, 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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YP2500X	Professional Counselor	5793	CO
3	101YA0400X	Addiction (Substance Use Disorder) Counselor	418	CO

General Provider Information

NPI Number	:	1659574671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEEDEE SHAFFER LPC, LAC, NCC

Provider Business Mailing Address
First Line	:	695 SADDLEMOUNTAIN RD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-2029
Country	:	US
Telephone Number	:	719-243-2184
Fax Number	:

Provider Business Practice Location Address
First Line	:	1852 IRWIN DR BLDG 1059
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80913-4176
Country	:	US
Telephone Number	:	719-526-8735
Fax Number	:

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

Provider Enumeration Date	:	06/07/2007
Last Update Date	:	02/05/2021

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