Healthcare Provider Details

I. General information

NPI: 1649108408
Provider Name (Legal Business Name): KRISTAN SHAW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2865 REGAL CIR APT G
HOOVER AL
35216-4665
US

IV. Provider business mailing address

2865 REGAL CIR APT G
HOOVER AL
35216-4665
US

V. Phone/Fax

Practice location:
  • Phone: 205-616-2412
  • Fax:
Mailing address:
  • Phone: 205-616-2412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: