Provider Demographics
NPI:1083473292
Name:SHAW-MEADOW, KATHRYN JOAN (MA, LPC)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:JOAN
Last Name:SHAW-MEADOW
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 PERRY CT APT 2
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-6212
Mailing Address - Country:US
Mailing Address - Phone:210-259-5007
Mailing Address - Fax:
Practice Address - Street 1:512 W CRAIG PL
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-3465
Practice Address - Country:US
Practice Address - Phone:210-504-6029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX84766101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health