Provider Demographics
NPI:1356629125
Name:SHAW, AARON LOYEL (PHD, LMFT)
Entity Type:Individual
Prefix:DR
First Name:AARON
Middle Name:LOYEL
Last Name:SHAW
Suffix:
Gender:M
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 PINE HOLLOW PL
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510-2739
Mailing Address - Country:US
Mailing Address - Phone:813-992-3751
Mailing Address - Fax:
Practice Address - Street 1:150 E BLOOMINGDALE AVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-8151
Practice Address - Country:US
Practice Address - Phone:813-992-3751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-28
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT 2571106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist