Provider Demographics
NPI:1649933680
Name:SHAFFER, ALYSSA (MA, LAC, NCC)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:MA, LAC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16648 N 19TH PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-6232
Mailing Address - Country:US
Mailing Address - Phone:602-819-0376
Mailing Address - Fax:
Practice Address - Street 1:16648 N 19TH PL
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-6232
Practice Address - Country:US
Practice Address - Phone:602-819-0376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-18
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-16196101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health