Healthcare Provider Details

I. General information

NPI: 1164753752
Provider Name (Legal Business Name): JENNIFER GRACE SHAW LMHC, CPT, CWS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2010
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7312 35TH STREET CT W APT 6
UNIVERSITY PLACE WA
98466-4435
US

IV. Provider business mailing address

7312 35TH STREET CT W APT 6
UNIVERSITY PLACE WA
98466-4435
US

V. Phone/Fax

Practice location:
  • Phone: 808-344-5404
  • Fax:
Mailing address:
  • Phone: 808-344-5404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number256964
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC 207
License Number StateHI
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60703859
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: