Healthcare Provider Details

I. General information

NPI: 1093622094
Provider Name (Legal Business Name): MS. DARCUS ELIZABETH SHAW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5440 N 64TH ST
MILWAUKEE WI
53218-3020
US

IV. Provider business mailing address

4430 W ROOSEVELT DR
MILWAUKEE WI
53216-2406
US

V. Phone/Fax

Practice location:
  • Phone: 414-393-5230
  • Fax:
Mailing address:
  • Phone: 414-393-5230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number606321
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: