Provider Demographics
NPI:1154553295
Name:SHAW, KANDI DENISE (LPC)
Entity type:Individual
Prefix:MRS
First Name:KANDI
Middle Name:DENISE
Last Name:SHAW
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 S FILES ST
Mailing Address - Street 2:
Mailing Address - City:ITASCA
Mailing Address - State:TX
Mailing Address - Zip Code:76055-3001
Mailing Address - Country:US
Mailing Address - Phone:254-707-0058
Mailing Address - Fax:
Practice Address - Street 1:1014 FERRIS AVE
Practice Address - Street 2:STE 2154
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-2591
Practice Address - Country:US
Practice Address - Phone:254-592-3385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-21
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63352101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional