Healthcare Provider Details

I. General information

NPI: 1457509739
Provider Name (Legal Business Name): CATHERINE JARVIS SHAW PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2008
Last Update Date: 08/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 NE 13TH ST 116 C
OKLAHOMA CITY OK
73104-5007
US

IV. Provider business mailing address

921 NE 13TH ST 116 C
OKLAHOMA CITY OK
73104-5007
US

V. Phone/Fax

Practice location:
  • Phone: 405-270-0501
  • Fax: 405-270-1566
Mailing address:
  • Phone: 405-270-0501
  • Fax: 405-270-1566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number240
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: