Provider Demographics
NPI:1174717706
Name:SHAFER, LARRY JAMES
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:JAMES
Last Name:SHAFER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 EL CALLE JON
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-4719
Mailing Address - Country:US
Mailing Address - Phone:805-720-3774
Mailing Address - Fax:
Practice Address - Street 1:115 E FESLER ST
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-4404
Practice Address - Country:US
Practice Address - Phone:805-922-6597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-27
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)