Provider Demographics
NPI:1992325484
Name:SHAW, JULIE MARIE (LMSW)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:MARIE
Last Name:SHAW
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:MARIE
Other - Last Name:MCCOMB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5843 DUNN RD
Mailing Address - Street 2:
Mailing Address - City:CASEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48725-9706
Mailing Address - Country:US
Mailing Address - Phone:989-551-8827
Mailing Address - Fax:
Practice Address - Street 1:5843 DUNN RD
Practice Address - Street 2:
Practice Address - City:CASEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48725-9706
Practice Address - Country:US
Practice Address - Phone:989-551-8827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-24
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011091311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1629601349OtherBRITTANY LUTREN LLC D.B.A. NIYAMA CENTER