Provider Demographics
NPI:1235524448
Name:SHAW, MONICA RENEE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:RENEE
Last Name:SHAW
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:401 E 10TH AVE STE 330
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3357
Mailing Address - Country:US
Mailing Address - Phone:541-868-2004
Mailing Address - Fax:541-868-2003
Practice Address - Street 1:887 NW GRANT AVE
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-4539
Practice Address - Country:US
Practice Address - Phone:541-868-2004
Practice Address - Fax:541-868-2003
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-03
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178004386101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional