Provider Demographics
NPI:1760517106
Name:SHAW, LEANN REESE (MA)
Entity Type:Individual
Prefix:MS
First Name:LEANN
Middle Name:REESE
Last Name:SHAW
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:LEANN
Other - Middle Name:CHRISTINE
Other - Last Name:REESE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:1911 MAIN AVE
Mailing Address - Street 2:SUITE 248
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-5078
Mailing Address - Country:US
Mailing Address - Phone:970-903-4607
Mailing Address - Fax:970-469-7221
Practice Address - Street 1:1911 MAIN AVE
Practice Address - Street 2:SUITE 248
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5078
Practice Address - Country:US
Practice Address - Phone:970-903-4607
Practice Address - Fax:970-469-7221
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
978106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO978OtherLMFT