MEDICARE: MICHELE SHAW

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

General Provider Information

NPI Number	:	1679301089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELE SHAW

Provider Business Mailing Address
First Line	:	1211 S MAIN ST STE 300-A
Second Line	:
City	:	KELLER
State	:	TX
Zip	:	76248-0818
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1211 S MAIN ST STE 300-A
Second Line	:
City	:	KELLER
State	:	TX
Zip	:	76248-0818
Country	:	US
Telephone Number	:	682-325-7447
Fax Number	:

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

Provider Enumeration Date	:	07/25/2024
Last Update Date	:	07/25/2024

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Directions to “ MICHELE SHAW ” Practice Location

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