Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 4815 | NE |
N | 101YM0800X | Mental Health Counselor | 9017 | NE |
NPI | 1003113580 |
---|---|
Provider Name | Ms. Diana M Shaw |
First Address | Omaha, NE 68114-4623 |
Second Address | Omaha, NE 68114-4623 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/02/2011 |
Last Update Date | 10/10/2016 |