Provider Demographics
NPI:1194091363
Name:SHAW, JOY RAE (PSYCHOLOGIST)
Entity type:Individual
Prefix:MRS
First Name:JOY
Middle Name:RAE
Last Name:SHAW
Suffix:
Gender:
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3751 WHEELER RD
Mailing Address - Street 2:
Mailing Address - City:SNOVER
Mailing Address - State:MI
Mailing Address - Zip Code:48472-9204
Mailing Address - Country:US
Mailing Address - Phone:989-286-3201
Mailing Address - Fax:989-286-3201
Practice Address - Street 1:302 NORTH STREET
Practice Address - Street 2:
Practice Address - City:CARO
Practice Address - State:MI
Practice Address - Zip Code:48723-9308
Practice Address - Country:US
Practice Address - Phone:903-393-9219
Practice Address - Fax:989-286-3201
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-31
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6361003745103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist