Jason Thomas Shaw

Primary specialty

Counseling PsychologistTaxonomy code 103TC1900X

License

6362009479 Issued in MI

Practice address

407 S Occidental Rd
Tecumseh, MI 49286-1611

Phone

(734) 335-0877

NPI assigned

Feb 11, 2022

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Christian Care Connection LLC

  • Mental Health Counselor
  • Lambertville, MI
  • NPI 1205983038
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1644537600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644796800000",
    "number": "1053065797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6530 SECOR RD STE 10",
            "city": "LAMBERTVILLE",
            "state": "MI",
            "postal_code": "481449456",
            "telephone_number": "734-854-7061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "407 S OCCIDENTAL RD",
            "city": "TECUMSEH",
            "state": "MI",
            "postal_code": "492861611",
            "telephone_number": "734-335-0877"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAW",
        "first_name": "JASON",
        "middle_name": "THOMAS",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-02-11",
        "last_updated": "2022-02-14",
        "certification_date": "2022-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "MI",
            "license": "6362009479",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Beverly Seeburger
• Kelsey Seegert
• Carol Corey Serafin, LMSW
• Joseph Jude Serafin Jr., LMSW
• Jayesh R Shah, MD
• Dennis Norbert Shelle, MD
• Shivaay 1 PLLC
• Shopko Stores Operating Co LLC
• Eric P Smith, DO
• Elizabeth Jane Snelling

• Counseling Psychologist in Tecumseh, MI
• Providers in Tecumseh, MI by specialty
• Counseling Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.