Provider Demographics
NPI:1043992225
Name:SHAW, DESIREE (MS, PLPC)
Entity type:Individual
Prefix:
First Name:DESIREE
Middle Name:
Last Name:SHAW
Suffix:
Gender:F
Credentials:MS, PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17399 LES CHENIER ST
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-4665
Mailing Address - Country:US
Mailing Address - Phone:225-802-0868
Mailing Address - Fax:
Practice Address - Street 1:17399 LES CHENIER ST
Practice Address - Street 2:
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-4665
Practice Address - Country:US
Practice Address - Phone:225-802-0868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPLC8765101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor