Provider Demographics
NPI:1760542922
Name:SHAW, DAVID ALLEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALLEN
Last Name:SHAW
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 S.E. MORRISON ST.
Mailing Address - Street 2:SUITE 530
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-2346
Mailing Address - Country:US
Mailing Address - Phone:503-644-0152
Mailing Address - Fax:
Practice Address - Street 1:516 S.E. MORRISON ST
Practice Address - Street 2:SUITE 530
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-2346
Practice Address - Country:US
Practice Address - Phone:503-644-0152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2011-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR381103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist