MEDICARE: MEGAN ELIZABETH SHAW LMFT, LADC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	303908	MN
2	106H00000X	Marriage & Family Therapist	2930	MN

General Provider Information

NPI Number	:	1033481981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN ELIZABETH SHAW LMFT, LADC

Provider Business Mailing Address
First Line	:	1405 LILAC DR N STE 151
Second Line	:
City	:	GOLDEN VALLEY
State	:	MN
Zip	:	55422-4536
Country	:	US
Telephone Number	:
Fax Number	:	763-951-3097

Provider Business Practice Location Address
First Line	:	1405 LILAC DR N STE 151
Second Line	:
City	:	GOLDEN VALLEY
State	:	MN
Zip	:	55422-4536
Country	:	US
Telephone Number	:	763-525-1746
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2012
Last Update Date	:	07/12/2019

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