Provider Demographics
NPI:1306660352
Name:SHAW, WILMA KAY
Entity type:Individual
Prefix:
First Name:WILMA
Middle Name:KAY
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 1:2410 PHEASANT CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77498-1965
Mailing Address - Country:US
Mailing Address - Phone:281-743-5214
Mailing Address - Fax:
Practice Address - Street 1:2410 PHEASANT CREEK DR
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77498-1965
Practice Address - Country:US
Practice Address - Phone:281-743-5214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-14
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst