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General NPI Number Information
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NPI Number | 1356629125
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Entity Type | Individual
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Provider Name | AARON LOYEL SHAW PH.D., LMFT
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Gender | Male
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Dates
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Enumeration Date | 07/28/2011
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Last Update Date | 07/28/2011
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Provider Practice Location Address
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Address Line | 150 E BLOOMINGDALE AVE
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City | BRANDON
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State | FL
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Zip | 33511-8151
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Country | US
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Telephone | 813-992-3751
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Fax |
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Provider Business Mailing Address
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Address Line | 903 PINE HOLLOW PL
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City | BRANDON
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State | FL
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Zip | 33510-2739
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Country | US
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Telephone | 813-992-3751
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MT 2571
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License Number State | FL
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