Healthcare Provider Details

I. General information

NPI: 1518311232
Provider Name (Legal Business Name): LYNDI ELIZABETH SHAW M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH SHAW M.A.

II. Dates (important events)

Enumeration Date: 04/19/2016
Last Update Date: 04/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2830 I ST STE 306
SACRAMENTO CA
95816-4311
US

IV. Provider business mailing address

2830 I ST STE 306
SACRAMENTO CA
95816-4311
US

V. Phone/Fax

Practice location:
  • Phone: 916-722-7792
  • Fax:
Mailing address:
  • Phone: 916-722-7792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPSB 94022177
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License NumberPSB 94022177
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License NumberPSB 94022177
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPSB 94022177
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSB 94022177
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSB 94022177
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSB 94022177
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberPSB 94022177
License Number StateCA
# 9
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License NumberPSB 94022177
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: