Provider Demographics
NPI:1164753752
Name:SHAW, JENNY GRACE (LMHC, CPT, CWS)
Entity Type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:GRACE
Last Name:SHAW
Suffix:
Gender:F
Credentials:LMHC, CPT, CWS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 S KIHEI RD
Mailing Address - Street 2:B201
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-8154
Mailing Address - Country:US
Mailing Address - Phone:808-344-5404
Mailing Address - Fax:
Practice Address - Street 1:1450 S KIHEI RD
Practice Address - Street 2:B201
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-8154
Practice Address - Country:US
Practice Address - Phone:808-344-5404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-20
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI256964101YM0800X
HIMHC 207101YM0800X
WALH60703859101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health