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General NPI Number Information
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NPI Number | 1154178010
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Entity Type | Individual
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Provider Name | KERRI RENAE SHAW
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Gender | Female
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Dates
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Enumeration Date | 04/30/2024
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Last Update Date | 06/14/2025
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Provider Practice Location Address
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Address Line | 1071 W BLUE STARR DR STE 101
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City | CLAREMORE
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State | OK
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Zip | 74017-2869
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Country | US
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Telephone | 918-760-2243
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Fax |
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Provider Business Mailing Address
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Address Line | 24655 S ELIZA DR
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City | CLAREMORE
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State | OK
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Zip | 74019-1856
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Country | US
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Telephone | 918-760-2243
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LPCCANDIDATE11572
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 11572
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License Number State | OK
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