Provider Demographics
NPI:1902115181
Name:SHAW, TERRANCE J
Entity type:Individual
Prefix:
First Name:TERRANCE
Middle Name:J
Last Name:SHAW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1489 W WARM SPRINGS RD
Mailing Address - Street 2:110
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-7635
Mailing Address - Country:US
Mailing Address - Phone:702-561-7395
Mailing Address - Fax:
Practice Address - Street 1:1489 W WARM SPRINGS RD
Practice Address - Street 2:110
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-7635
Practice Address - Country:US
Practice Address - Phone:702-561-7395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor