Provider Demographics
NPI:1699055459
Name:SHAW, RICHARD ANTHONY (CAMFT)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:ANTHONY
Last Name:SHAW
Suffix:
Gender:M
Credentials:CAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 W GRAY ST
Mailing Address - Street 2:SUITE 406
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-7129
Mailing Address - Country:US
Mailing Address - Phone:405-306-8597
Mailing Address - Fax:
Practice Address - Street 1:214 SW 30TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-6506
Practice Address - Country:US
Practice Address - Phone:405-272-1610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2N96-341-0804174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK45-1779723OtherFEIN