1568746923 NPI number — MRS. MAILEE SUSANNE SHAW LMFT

Table of content: MRS. MAILEE SUSANNE SHAW LMFT (NPI 1568746923)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568746923 NPI number — MRS. MAILEE SUSANNE SHAW LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHAW
Provider First Name:
MAILEE
Provider Middle Name:
SUSANNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TURNER
Provider Other First Name:
MAILEE
Provider Other Middle Name:
SUSANNE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMFT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1568746923
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/27/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11086 AFRICAN SUNSET ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HENDERSON
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89052-8615
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-370-0784
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2298 W HORIZON RIDGE PKWY STE 108
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HENDERSON
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-370-0784
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/04/2011

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:  MI0282 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X , with the licence number: 01274 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1568746923 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".