MEDICARE: DR. REBECCA MARIE SHAW PHD, 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	487	AK

General Provider Information

NPI Number	:	1750410585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REBECCA MARIE SHAW PHD, LPC

Provider Business Mailing Address
First Line	:	9535 W LAKE DR
Second Line	:
City	:	EAGLE RIVER
State	:	AK
Zip	:	99577-9568
Country	:	US
Telephone Number	:	907-440-2772
Fax Number	:

Provider Business Practice Location Address
First Line	:	9535 W LAKE DR
Second Line	:
City	:	EAGLE RIVER
State	:	AK
Zip	:	99577-9568
Country	:	US
Telephone Number	:	907-440-2772
Fax Number	:

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

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	07/08/2007

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