Doctor Name: | BRIAN D. SHAW |
NPI Number: | 1396949517 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | CM |
License Number: | 5606C |
Business Practice Address: | 204 Mississippi St S Wynne, AR - 723963025 |
Business Phone Number: | 8702088499 |
Business Fax Number: | 8702088044 |
Mailing Address: | 204 Mississippi St S, WYNNE |
State: | AR |
Postal Code: | 723963025 |
Phone Number: | 8702088499 |
Fax Number: | 8702088044 |
NPI Enumeration Date: | 06/12/2007 |
NPI Last Update Date: | 12/30/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 5606C |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AR |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |