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General NPI Number Information
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NPI Number | 1336332790
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Entity Type | Individual
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Provider Name | JOEY N. SHAW M. ED LPC
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Gender | Male
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Dates
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Enumeration Date | 08/20/2007
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Last Update Date | 05/29/2009
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Provider Practice Location Address
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Address Line | 501 E 15TH ST
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City | EDMOND
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State | OK
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Zip | 73013-5043
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Country | US
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Telephone | 405-308-3128
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Fax |
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Provider Business Mailing Address
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Address Line | 3905 N BRYANT AVE
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City | EDMOND
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State | OK
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Zip | 73034-4037
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Country | US
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Telephone | 405-308-3128
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 340
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License Number State | OK
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