Provider Demographics
NPI:1891388724
Name:SHAFFER, TIMOTHY WILLIAM (MS, LMFT)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:WILLIAM
Last Name:SHAFFER
Suffix:
Gender:M
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4414 N 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-4114
Mailing Address - Country:US
Mailing Address - Phone:602-285-5550
Mailing Address - Fax:602-285-5551
Practice Address - Street 1:4414 N 19TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-4114
Practice Address - Country:US
Practice Address - Phone:602-285-5550
Practice Address - Fax:602-285-5551
Is Sole Proprietor?:No
Enumeration Date:2021-02-11
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMFT-15888106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ15888OtherLICENSE