Doctor Name: | JULIETTE C SHAW |
NPI Number: | 1033554860 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS, LCPC |
License Number: | 4472 |
Business Practice Address: | 2050 Fairway Drive 104 Bozeman, MT - 59715 |
Business Phone Number: | 4065706646 |
Business Fax Number: | |
Mailing Address: | 808 S. 6th Ave, BOZEMAN |
State: | MT |
Postal Code: | 59715 |
Phone Number: | 4065706646 |
Fax Number: | |
NPI Enumeration Date: | 05/07/2013 |
NPI Last Update Date: | 05/07/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 4472 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MT |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |