Provider Demographics
NPI:1598030314
Name:SHAW, CHRIS C JR (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:C
Last Name:SHAW
Suffix:JR
Gender:M
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-2725
Mailing Address - Country:US
Mailing Address - Phone:310-383-4629
Mailing Address - Fax:
Practice Address - Street 1:1110 CHURCH ST
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2725
Practice Address - Country:US
Practice Address - Phone:310-383-4629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-12
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-11-9392103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst