Healthcare Provider Details

I. General information

NPI: 1477080927
Provider Name (Legal Business Name): KATHLEEN MARIE SHAW LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2017
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 ROBERTS DR STE H
NEW ROADS LA
70760-2661
US

IV. Provider business mailing address

6450 LA HIGHWAY 1
BATCHELOR LA
70715-3212
US

V. Phone/Fax

Practice location:
  • Phone: 225-618-7800
  • Fax: 225-238-8330
Mailing address:
  • Phone: 225-618-5015
  • Fax: 225-442-3107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6700
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6700
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: