Individual
MYRANDA JO SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1751 SOUTHCROSS DR W, BURNSVILLE, MN 55306-7012
(952) 892-7690
Mailing address
1751 SOUTHCROSS DR W, BURNSVILLE, MN 55306-7012
(952) 892-7690
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
CC01890
—
Other
Enumeration date
08/14/2018
Last updated
08/14/2018
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