MEDICARE: MRS. MICHELLE ANN SHAW PSYD

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	106H00000X	Marriage & Family Therapist	108012	CA
2	106H00000X	Marriage & Family Therapist	203565	TX

General Provider Information

NPI Number	:	1912385469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MICHELLE ANN SHAW PSYD

Provider Business Mailing Address
First Line	:	2802 FLINTROCK TRCE STE 210
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78738-1744
Country	:	US
Telephone Number	:	512-400-4186
Fax Number	:

Provider Business Practice Location Address
First Line	:	2802 FLINTROCK TRCE STE 210
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78738-1744
Country	:	US
Telephone Number	:	512-400-4186
Fax Number	:

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

Provider Enumeration Date	:	05/15/2015
Last Update Date	:	12/09/2024

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