Individual
JAYDA KEYERRA BLOUNT SHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
10775 PIONEER TRL STE 215, TRUCKEE, CA 96161-0234
(415) 424-4266
(415) 520-6633
Mailing address
10775 PIONEER TRL STE 215, TRUCKEE, CA 96161-0234
(415) 424-4266
(415) 520-6633
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
ADT1995
MD
101YP2500X
Professional Counselor
Primary
LC12586
MD
Other
Enumeration date
07/25/2019
Last updated
11/06/2022
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