Individual
KEVIN B SHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCP
Contact information
Practice address
109 W 2ND ST, OTTAWA, KS 66067-2212
(785) 242-2991
(785) 242-4401
Mailing address
1953 RENO RD, OTTAWA, KS 66067-8754
(785) 242-8059
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
137
KS
103TC0700X
Clinical Psychologist
Primary
065
KS
Other
Enumeration date
07/27/2006
Last updated
07/02/2024
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