Individual
MRS. JACKIE L. SHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.ED,, LPC, LMFT
Contact information
Practice address
307 E DANFORTH RD, SUITE 118, EDMOND, OK 73034-4483
(405) 285-4700
(405) 285-4767
Mailing address
PO BOX 755, CRESCENT, OK 73028-0755
(405) 550-1038
(405) 285-4767
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC #1123, LMFT#655
OK
Other
Enumeration date
06/13/2007
Last updated
07/27/2016
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