MRS. JACKIE L. SHAW (NPI# 1023212891) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023212891 |
| Entity Type | Individual |
| Full Name | MRS. JACKIE L. SHAW |
| Other Name | JACKIE L WHITE |
| Credential | M.ED,, LPC, LMFT |
| Practice Address |
307 E Danforth Rd Suite 118 Edmond OK 73034-4483 |
| Mailing Address |
Po Box 755 Crescent OK 73028-0755 |
| Practice Telephone | 4052854700 |
| Practice Fax Number | 4052854767 |
| Mailing Telephone | 4055501038 |
| Mailing Fax Number | 4052854767 |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2016-07-27 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YP2500X |
Counselor Specialization: Professional |
LPC #1123, LMFT# | OK | Behavioral Health & Social Service Providers |
| Street Address |
307 E DANFORTH RD SUITE 118 |
| City | EDMOND |
| State | OK |
| Zip Code | 73034-4483 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912902842 | David L Graham | Specialist | 307 E Danforth Rd, Suite 154, Edmond, OK 73034-4483 | 2005-06-16 |
| 1346773058 | Onelife Treatment LLC | Community/Behavioral Health | 307 E Danforth Rd, Suite 118, Edmond, OK 73034-4483 | 2017-04-10 |
| 1477009660 | Kayla Michelle Martel | Counselor | 307 E Danforth Rd, #124, Edmond, OK 73034-4483 | 2016-08-29 |
| 1316318694 | Alan Wishard | Counselor | 307 E Danforth Rd, Edmond, OK 73034-4483 | 2015-10-13 |
| 1588041560 | Coraspire Mental Health and Wellness Center, Inc. | Case Management | 307 E Danforth Rd, Suite 124, Edmond, OK 73034-4483 | 2015-04-29 |
| 1790068864 | Edmond Hearing Doctors Pllc | Clinic/Center | 307 E Danforth Rd, Suite 118, Edmond, OK 73034-4483 | 2011-09-24 |
| 1285924837 | Graham Dermatology Center, P.C. | Dermatology | 307 E Danforth Rd, Suite 154, Edmond, OK 73034-4483 | 2011-04-17 |
| 1194036129 | Abbey Lynn Blair | Counselor | 307 E Danforth Rd, Suite 124, Edmond, OK 73034-4483 | 2010-06-24 |
| 1427286871 | Angela Diane Schmidt | Chiropractor | 307 E Danforth Rd, Suite 154, Edmond, OK 73034-4483 | 2009-06-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306447172 | Saints Medical Group, LLC | Family Medicine | 2749 Progressive Dr, Suite B, Edmond, OK 73034 | 2020-11-06 |
| 1194339861 | Susan Haesook Kim | Pharmacist | 1400 2nd St, Edmod, Edmond, OK 73034 | 2020-09-01 |
| 1821616038 | Aaron Michael Gowens | Specialist/Technologist | 015 Wantland Hall 100 University Dr., Edmond, OK 73034 | 2020-07-14 |
| 1043834849 | Paddington Place Lcc | Intermediate Care Facility, Mental Illness | 3225 French Park Drive, Suite 6, Edmond, OK 73034 | 2020-06-08 |
| 1083254932 | Purpose Healthcare Inc | Psychologist | 301 South Blvd, Suite 117, Edmond, OK 73034 | 2020-01-08 |
| 1740773662 | Healthcare Express, LLP | Family Medicine | 2300 E 2nd St, Edmond, OK 73034 | 2018-06-14 |
| 1427555713 | Sara Nicole Smith | Specialist/Technologist | 100 N University Drive, Attn: Athletic Training Room, Edmond, OK 73034 | 2018-04-12 |
| 1619475084 | Carissa Leigh Brackelsberg | Chiropractor | 3709 E 2nd St, Edmond, OK 73034 | 2018-01-31 |
| 1760996177 | Laurel Michelle Glendening | Physical Therapist | 3531 River Wood Lane, Edmond, OK 73034 | 2017-11-21 |
| 1134643380 | Keith S Quinn | Dentist | 3008 Peaceful Ln, Edmond, OK 73034 | 2017-07-31 |
| Find all providers in zip 73034 | ||||
| Taxonomy Code | 101YP2500X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Professional |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164034898 | Heather Jean Miller | Counselor | 1320 E 9th St Ste 8, Edmond, OK 73034-5773 | 2020-08-24 |
| 1225640337 | Michelle Davis Gannaway | Counselor | 13315 N Coltrane Rd, Edmond, OK 73013-8257 | 2020-08-19 |
| 1871132316 | Jaime Sue Taylor | Counselor | 26 E 9th St Ste B, Edmond, OK 73034-3911 | 2020-01-01 |
| 1124675749 | Kelly Love Wallace | Counselor | 2817 Stonebrook Rd, Edmond, OK 73003-2105 | 2019-08-19 |
| 1346704996 | Forward Momentum | Counselor | 1600 E 15th St Ste 503, Edmond, OK 73013-6690 | 2019-01-29 |
| 1952885030 | Cathy Ann Angier | Counselor | 1601 S State St Ste 400, Edmond, OK 73013-3697 | 2018-09-24 |
| 1639655400 | Hannah Elise Cordero | Counselor | 2120 S Broadway, Edmond, OK 73013-4021 | 2018-07-16 |
| 1306350368 | Stanley Michael Daniel | Counselor | 3116 Ne 138th St, Edmond, OK 73013-7068 | 2017-11-28 |
| 1699285601 | Jill Nichols | Counselor | 2221 E Memorial Rd, Edmond, OK 73013-5518 | 2017-10-04 |
| 1952857039 | Shae Gregston | Counselor | 2101 Brookview Ln, Edmond, OK 73034-4848 | 2016-08-29 |
| Find all providers in EDMOND | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.