Individual
KELLY GRACE SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, LPC, NCC
Contact information
Practice address
770 E 11TH AVE FL SSB2, EUGENE, OR 97401-3746
(458) 205-7085
(458) 205-7089
Mailing address
PO BOX 18, VIDA, OR 97488-0018
(541) 771-1017
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
OR
Other
Enumeration date
05/17/2019
Last updated
11/14/2023
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