Provider Demographics
NPI:1215080965
Name:SCHAFER, SHELLY JO (LMHC)
Entity type:Individual
Prefix:MRS
First Name:SHELLY
Middle Name:JO
Last Name:SCHAFER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12852 185TH ST
Mailing Address - Street 2:
Mailing Address - City:WELLSBURG
Mailing Address - State:IA
Mailing Address - Zip Code:50680-7639
Mailing Address - Country:US
Mailing Address - Phone:641-869-3450
Mailing Address - Fax:641-869-3450
Practice Address - Street 1:101 WEST MAIN ST.
Practice Address - Street 2:
Practice Address - City:ZEARING
Practice Address - State:IA
Practice Address - Zip Code:50278
Practice Address - Country:US
Practice Address - Phone:515-689-4994
Practice Address - Fax:515-689-4994
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00989101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health