Provider Demographics
NPI:1225758287
Name:SHAW, LISABETH LONG (LPC)
Entity Type:Individual
Prefix:
First Name:LISABETH
Middle Name:LONG
Last Name:SHAW
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7908 CINCINNATI DAYTON RD STE P
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-6630
Mailing Address - Country:US
Mailing Address - Phone:513-613-3848
Mailing Address - Fax:
Practice Address - Street 1:7908 CINCINNATI DAYTON RD STE P
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-6630
Practice Address - Country:US
Practice Address - Phone:513-613-3848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2204029101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health