Healthcare Provider Details

I. General information

NPI: 1851225452
Provider Name (Legal Business Name): DAVID ULLYSSES SHAW MFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2677 ZOE AVE # 220
HUNTINGTON PARK CA
90255-4195
US

IV. Provider business mailing address

13124 STANFORD AVE
LOS ANGELES CA
90059-3342
US

V. Phone/Fax

Practice location:
  • Phone: 310-757-3458
  • Fax:
Mailing address:
  • Phone: 562-965-1250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: