Provider Demographics
NPI:1548097645
Name:SHAW, JOHN (LMHCA)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:SHAW
Suffix:
Gender:U
Credentials:LMHCA
Other - Prefix:
Other - First Name:JACK
Other - Middle Name:
Other - Last Name:SHAW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:SHIMOMEGURO 6-20-6-304
Mailing Address - Street 2:
Mailing Address - City:MEGURO
Mailing Address - State:ZZ - FOREIGN COUNTRIES
Mailing Address - Zip Code:1530064
Mailing Address - Country:JP
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:SHIMOMEGURO 6-20-6-304
Practice Address - Street 2:
Practice Address - City:MEGURO
Practice Address - State:ZZ - FOREIGN COUNTRIES
Practice Address - Zip Code:1530064
Practice Address - Country:JP
Practice Address - Phone:080-537-7823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-14
Last Update Date:2024-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61582723101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health