Provider Demographics
NPI:1285988261
Name:SHAFFER, MICHELE DENISE (BS)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:DENISE
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:MICHELEQ
Other - Middle Name:DENISE
Other - Last Name:NEEDHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:ANTLERS
Mailing Address - State:OK
Mailing Address - Zip Code:74523-0309
Mailing Address - Country:US
Mailing Address - Phone:405-401-8234
Mailing Address - Fax:
Practice Address - Street 1:612 E CENTRAL ST
Practice Address - Street 2:
Practice Address - City:HUGO
Practice Address - State:OK
Practice Address - Zip Code:74743-8034
Practice Address - Country:US
Practice Address - Phone:580-768-3895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor