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General NPI Number Information
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NPI Number | 1578780912
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Entity Type | Individual
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Provider Name | CARRIE BETH SHAW LPC
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Gender | Female
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 11/04/2025
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Provider Practice Location Address
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Address Line | 411 N FREDONIA ST STE 114
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City | LONGVIEW
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State | TX
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Zip | 75601-6467
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Country | US
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Telephone | 903-238-6924
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Fax | 409-877-1363
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Provider Business Mailing Address
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Address Line | PO BOX 612
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City | JUDSON
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State | TX
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Zip | 75660-0612
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Country | US
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Telephone | 903-238-6924
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Fax | 409-877-1363
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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 | 16092
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License Number State | TX
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