| Doctor Name: | ELIZABETH SHAW |
| NPI Number: | 1013304591 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 64093 |
| Business Practice Address: | 2121 W Waco Dr Waco, TX - 767073480 |
| Business Phone Number: | 2542356542 |
| Business Fax Number: | 2542356254 |
| Mailing Address: | 2121 W Waco Dr, WACO |
| State: | TX |
| Postal Code: | 767073480 |
| Phone Number: | 2542356542 |
| Fax Number: | 2542356254 |
| NPI Enumeration Date: | 04/22/2015 |
| NPI Last Update Date: | 04/22/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 64093 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |