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1639286321

NPI Code Detail

MEDICARE: REBECCA JANEL SHAW LMHC

MEDICARE: REBECCA JANEL SHAW LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LH00007673	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	910564952	OTHER	WA	PREMERA
2	910564952	OTHER	WA	FIRST CHOICE NETWORK
3	91056495299201A011	OTHER	WA	TRICARE
4	279496	OTHER	WA	MANAGED HEALTHCARE NETWOR
5	7065CL	OTHER	WA	ASURIS NORTHWEST

General Provider Information

NPI Number	:	1639286321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA JANEL SHAW LMHC

Provider Business Mailing Address
First Line	:	203 N WASHINGTON ST
Second Line	:	STE300
City	:	SPOKANE
State	:	WA
Zip	:	99201-0233
Country	:	US
Telephone Number	:	509-838-4128
Fax Number	:	509-838-4816

Provider Business Practice Location Address
First Line	:	1720 2ND ST
Second Line	:
City	:	CHENEY
State	:	WA
Zip	:	99004-1910
Country	:	US
Telephone Number	:	509-444-8200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	03/08/2016

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Directions to “ REBECCA JANEL SHAW LMHC” Practice Location

Language	Start Address	Practice Location

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