MEDICARE: MS. JAN RENET SHAW M.ED., LPC-A

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	101YP2500X	Professional Counselor	91302	TX

General Provider Information

NPI Number	:	1902598543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JAN RENET SHAW M.ED., LPC-A

Provider Business Mailing Address
First Line	:	PO BOX 742
Second Line	:
City	:	BIG SPRING
State	:	TX
Zip	:	79721-0742
Country	:	US
Telephone Number	:	432-466-1696
Fax Number	:

Provider Business Practice Location Address
First Line	:	702 JOHNSON ST
Second Line	:
City	:	BIG SPRING
State	:	TX
Zip	:	79720-2820
Country	:	US
Telephone Number	:	432-466-1696
Fax Number	:

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

Provider Enumeration Date	:	05/23/2023
Last Update Date	:	05/23/2023

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