| Lee Shaw Jr, Llc | |
|
6809 Indiana Ave Ste 166 Riverside CA 92506-4221 | |
| (951) 500-9658 | |
| Not Available |
| Full Name | Lee Shaw Jr, Llc |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 6809 Indiana Ave Ste 166, Riverside, California |
| Authorized Official Name and Position | Lee Shaw (OWNER) |
| Authorized Official Contact | 9515009658 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lee Shaw Jr, Llc 6809 Indiana Ave Ste 166 Riverside CA 92506-4221 Ph: (951) 500-9658 | Lee Shaw Jr, Llc 6809 Indiana Ave Ste 166 Riverside CA 92506-4221 Ph: (951) 500-9658 |
| NPI Number | 1740796531 |
|---|---|
| Provider Enumeration Date | 12/16/2017 |
| Last Update Date | 11/05/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740796531 | NPI | - | NPPES |
| 97306 | Other | CA | LMFT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | 97306 (California) | Primary |
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