Individual provider · Type 1 NPI
Jack William Shaw, ED.D., LMHC
Mental Health Counselor · St. Petersburg, FL
NPI number
1124623319
Active
Practice location
1735 Dr Mlk Jr Street South
St. Petersburg, FL 33705-2547
Mailing address
7780 49th St N # 254
Pinellas Park, FL 33781-3440
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | MCAP100243 (FL) |
| Mental Health Counselor Primary | 101YM0800X | MH21197 (FL) |
Mental Health Counselor: Definition to come...
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About NPI 1124623319
Jack William Shaw, ED.D., LMHC's National Provider Identifier is 1124623319, issued on Dec 3, 2020. The primary taxonomy on file is Mental Health Counselor (101YM0800X), and the practice location is in St. Petersburg, FL. The record was last updated on Nov 2, 2022.