1760517106 NPI number — MS. LEANN REESE SHAW MA

Table of content: MS. LEANN REESE SHAW MA (NPI 1760517106)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760517106 NPI number — MS. LEANN REESE SHAW MA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHAW
Provider First Name:
LEANN
Provider Middle Name:
REESE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
REESE
Provider Other First Name:
LEANN
Provider Other Middle Name:
CHRISTINE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMFT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1760517106
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1911 MAIN AVE
Provider Second Line Business Mailing Address:
SUITE 248
Provider Business Mailing Address City Name:
DURANGO
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81301-5078
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-903-4607
Provider Business Mailing Address Fax Number:
970-469-7221

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1911 MAIN AVE
Provider Second Line Business Practice Location Address:
SUITE 248
Provider Business Practice Location Address City Name:
DURANGO
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81301-5078
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-903-4607
Provider Business Practice Location Address Fax Number:
970-469-7221
Provider Enumeration Date:
02/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  978 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 978 . This is a "LMFT" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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