Provider Demographics
NPI:1699809194
Name:SHAW, RENEE D (LPC)
Entity type:Individual
Prefix:MS
First Name:RENEE
Middle Name:D
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 1:20500 EUREKA RD STE 200
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-6394
Mailing Address - Country:US
Mailing Address - Phone:517-882-3732
Mailing Address - Fax:517-882-3633
Practice Address - Street 1:20500 EUREKA RD STE 200
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-6394
Practice Address - Country:US
Practice Address - Phone:517-882-3732
Practice Address - Fax:517-882-3633
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401005504101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional