Provider Demographics
NPI:1144098781
Name:SHAW, CHERIE R (LCDC-MS, QMHP)
Entity type:Individual
Prefix:
First Name:CHERIE
Middle Name:R
Last Name:SHAW
Suffix:
Gender:F
Credentials:LCDC-MS, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 N HWY 360 STE 1904
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-1040
Mailing Address - Country:US
Mailing Address - Phone:469-460-7090
Mailing Address - Fax:469-460-7091
Practice Address - Street 1:2100 N HWY 360 STE 1904
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-1040
Practice Address - Country:US
Practice Address - Phone:469-460-7090
Practice Address - Fax:469-460-7091
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-13
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66592101YA0400X
TX17303101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)