Provider Demographics
NPI:1740497650
Name:SHAW, GWEN E (LMFT, LPC)
Entity type:Individual
Prefix:MRS
First Name:GWEN
Middle Name:E
Last Name:SHAW
Suffix:
Gender:F
Credentials:LMFT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8214 WESTCHESTER DR
Mailing Address - Street 2:SUITE 800
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-6100
Mailing Address - Country:US
Mailing Address - Phone:972-733-4566
Mailing Address - Fax:972-713-0901
Practice Address - Street 1:8214 WESTCHESTER DR
Practice Address - Street 2:SUITE 800
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-6100
Practice Address - Country:US
Practice Address - Phone:972-733-4566
Practice Address - Fax:972-713-0901
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX09808101YP2500X
TX000505106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist