MEDICARE: CHRISTINA MARIE SHAW LPC

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	101YM0800X	Mental Health Counselor	88189	TX

General Provider Information

NPI Number	:	1235810904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA MARIE SHAW LPC

Provider Business Mailing Address
First Line	:	14403 OAK CHASE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77062-2039
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14403 OAK CHASE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77062-2039
Country	:	US
Telephone Number	:	281-455-3142
Fax Number	:

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

Provider Enumeration Date	:	07/26/2023
Last Update Date	:	07/26/2023

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