Provider Demographics
NPI:1417430943
Name:SHAW, AMBER (LMFT)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:SHAW
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2390 LAS POSAS RD STE C
Mailing Address - Street 2:241
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-3437
Mailing Address - Country:US
Mailing Address - Phone:818-659-5114
Mailing Address - Fax:
Practice Address - Street 1:2390 LAS POSAS RD STE C
Practice Address - Street 2:241
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-3437
Practice Address - Country:US
Practice Address - Phone:818-659-5114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-11
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA124849106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA107737OtherBOARD OF BEHAVIOR SCIENCES