Provider Demographics
NPI:1124202189
Name:SHAW, TAMIKA (LMSW)
Entity Type:Individual
Prefix:
First Name:TAMIKA
Middle Name:
Last Name:SHAW
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 MURPHY RD STE B1173
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-5421
Mailing Address - Country:US
Mailing Address - Phone:346-368-4558
Mailing Address - Fax:281-676-5089
Practice Address - Street 1:12867 CAPRICORN ST
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-3915
Practice Address - Country:US
Practice Address - Phone:713-271-0040
Practice Address - Fax:281-277-1081
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-26
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX800713416L0300X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No3416L0300XTransportation ServicesAmbulanceLand Transport