Provider Demographics
NPI:1336332790
Name:SHAW, JOEY N (M ED LPC)
Entity Type:Individual
Prefix:MR
First Name:JOEY
Middle Name:N
Last Name:SHAW
Suffix:
Gender:M
Credentials:M ED LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3905 N BRYANT AVE
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-4037
Mailing Address - Country:US
Mailing Address - Phone:405-308-3128
Mailing Address - Fax:
Practice Address - Street 1:501 E 15TH ST
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-5043
Practice Address - Country:US
Practice Address - Phone:405-308-3128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-20
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK340101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional