Provider Demographics
NPI:1003113580
Name:SHAW, DIANA M (LMHP, RPT)
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:M
Last Name:SHAW
Suffix:
Gender:F
Credentials:LMHP, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 S 75TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-4623
Mailing Address - Country:US
Mailing Address - Phone:402-391-2477
Mailing Address - Fax:
Practice Address - Street 1:820 S 75TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-4623
Practice Address - Country:US
Practice Address - Phone:402-391-2477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-18
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE9017101YM0800X
NE4815101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health