Provider Demographics
NPI:1124174412
Name:SHRIFTER, LYLE STEPHEN (MSW)
Entity type:Individual
Prefix:MR
First Name:LYLE
Middle Name:STEPHEN
Last Name:SHRIFTER
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7630 CANNON AVE
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603-9498
Mailing Address - Country:US
Mailing Address - Phone:541-884-2357
Mailing Address - Fax:541-882-6406
Practice Address - Street 1:410 N 9TH ST
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-2805
Practice Address - Country:US
Practice Address - Phone:541-884-2357
Practice Address - Fax:541-882-6406
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical