Healthcare Provider Details

I. General information

NPI: 1033481981
Provider Name (Legal Business Name): MEGAN ELIZABETH SHAW LMFT, LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2012
Last Update Date: 07/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 LILAC DR N STE 151
GOLDEN VALLEY MN
55422-4536
US

IV. Provider business mailing address

1405 LILAC DR N STE 151
GOLDEN VALLEY MN
55422-4536
US

V. Phone/Fax

Practice location:
  • Phone: 763-525-1746
  • Fax:
Mailing address:
  • Phone:
  • Fax: 763-951-3097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number303908
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2930
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: