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Provider Information for 1801945324


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Dr. SCOTT D. SHAW D.Min.


Sex: Male

NPI: 1801945324
Last Updated: 2007-07-08
Certification Date:

Details

NameValue
NPI1801945324
Enumeration Date2007-01-10
NPI TypeNPI-1 Individual
Sole ProprietorNO
StatusActive
Mailing Address 3501 LAKE EASTBROOK BLVD SE
SUITE 280
GRAND RAPIDS, MI 49546-5938
United States

Phone: 616-942-7331 | Fax:616-942-8807
 
Primary Practice Address 3501 LAKE EASTBROOK BLVD SE
SUITE 280
GRAND RAPIDS, MI 49546-5938
United States

Phone: 616-942-7331 | Fax:616-942-8807
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 101YP2500X - Counselor - ProfessionalMI6401007864
No 1041C0700X - Social Worker - ClinicalMI6801081490