Provider Demographics
NPI:1124421706
Name:SHAW, EVA
Entity type:Individual
Prefix:
First Name:EVA
Middle Name:
Last Name:SHAW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 E UNIVERSITY AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-6814
Mailing Address - Country:US
Mailing Address - Phone:512-686-0207
Mailing Address - Fax:512-869-2940
Practice Address - Street 1:1221 W BEN WHITE BLVD
Practice Address - Street 2:SUITE B100/B200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-7192
Practice Address - Country:US
Practice Address - Phone:877-800-5722
Practice Address - Fax:512-326-1682
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-26
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX544221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical