MEDICARE: LOGAN ALEXANDER SHAFFER LPC-MHSP

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	8472	TN

General Provider Information

NPI Number	:	1881550796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOGAN ALEXANDER SHAFFER LPC-MHSP

Provider Business Mailing Address
First Line	:	1445 BRIDWELL ST
Second Line	:
City	:	KINGSPORT
State	:	TN
Zip	:	37664-3307
Country	:	US
Telephone Number	:	423-579-8047
Fax Number	:

Provider Business Practice Location Address
First Line	:	1570 WAVERLY RD
Second Line	:
City	:	KINGSPORT
State	:	TN
Zip	:	37664-2523
Country	:	US
Telephone Number	:	423-224-1353
Fax Number	:

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

Provider Enumeration Date	:	01/05/2026
Last Update Date	:	01/05/2026

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