Provider Demographics
NPI:1568746923
Name:SHAW, MAILEE SUSANNE (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:MAILEE
Middle Name:SUSANNE
Last Name:SHAW
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:MAILEE
Other - Middle Name:SUSANNE
Other - Last Name:TURNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:11086 AFRICAN SUNSET ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-8615
Mailing Address - Country:US
Mailing Address - Phone:702-370-0784
Mailing Address - Fax:
Practice Address - Street 1:2298 W HORIZON RIDGE PKWY STE 108
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052
Practice Address - Country:US
Practice Address - Phone:702-370-0784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-04
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMI0282106H00000X
NV01274106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1568746923Medicaid