Provider Demographics
NPI:1255662508
Name:SHAW, BRIAN KENNETH (MSW, LCSW, LMHP)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:KENNETH
Last Name:SHAW
Suffix:
Gender:M
Credentials:MSW, LCSW, LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1219 LEAVENWORTH ST STE 108
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68102-3214
Mailing Address - Country:US
Mailing Address - Phone:402-881-5475
Mailing Address - Fax:
Practice Address - Street 1:1299 FARNAM ST STE 335
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68102-1880
Practice Address - Country:US
Practice Address - Phone:402-881-5475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-27
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11421041C0700X
NE1275101YM0800X
NE2826101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical