Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
N | 101YP1600X | Pastoral Counselor | ||
Y | 101YP2500X | Professional Counselor |
NPI | 1255857439 |
---|---|
Provider Name | Mr. Brian Keith Shaffer |
First Address | Troy, MI 48099-4492 |
Second Address | Sterling Heights, MI 48310-4626 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2017 |
Last Update Date | 28/06/2020 |