Provider Demographics
NPI:1164221420
Name:SHAFER-MEYER, MITCHELL DOUGLAS (PPS)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:DOUGLAS
Last Name:SHAFER-MEYER
Suffix:
Gender:M
Credentials:PPS
Other - Prefix:
Other - First Name:MITCHELL
Other - Middle Name:DOUGLAS
Other - Last Name:MEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PPS
Mailing Address - Street 1:335 W SACRAMENTO AVE
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-4580
Mailing Address - Country:US
Mailing Address - Phone:530-891-3090
Mailing Address - Fax:
Practice Address - Street 1:335 W SACRAMENTO AVE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-4580
Practice Address - Country:US
Practice Address - Phone:530-891-3090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool