Provider Demographics
NPI:1902598543
Name:SHAW, JAN RENET (MED, LPC-A)
Entity Type:Individual
Prefix:MS
First Name:JAN
Middle Name:RENET
Last Name:SHAW
Suffix:
Gender:F
Credentials:MED, LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 742
Mailing Address - Street 2:
Mailing Address - City:BIG SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:79721-0742
Mailing Address - Country:US
Mailing Address - Phone:432-466-1696
Mailing Address - Fax:
Practice Address - Street 1:702 JOHNSON ST
Practice Address - Street 2:
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720-2820
Practice Address - Country:US
Practice Address - Phone:432-466-1696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX91302101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional