Doctor Name: | MRS. JACKIE L. SHAW |
NPI Number: | 1023212891 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.ED,, LPC, LMFT |
License Number: | LPC #1123, LMFT#655 |
Business Practice Address: | 307 E Danforth Rd Suite 118 Edmond, OK - 730344483 |
Business Phone Number: | 4052854700 |
Business Fax Number: | 4052854767 |
Mailing Address: | Po Box 755, CRESCENT |
State: | OK |
Postal Code: | 730280755 |
Phone Number: | 4052854700 |
Fax Number: | 4052854767 |
NPI Enumeration Date: | 06/13/2007 |
NPI Last Update Date: | 05/09/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | LPC #1123, LMFT#655 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OK |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |