Martin K Shaw, LPC, LMFT

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

63283 Issued in TX

Practice address

12650 N Beach St Ste 114
Fort Worth, TX 76244-4245

Phone

(940) 432-8631

NPI assigned

Mar 11, 2009

Last updated

Jun 27, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Micah Boyer MDGroup PAC ID 8426482159, 15 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Micah Boyer MD

  • Family Medicine Physician
  • Wichita Falls, TX
  • NPI 1114564085
  Medicare reassignment Care Compare group NPD
• Tmho LLC Texasmentalhealthonline

  • Mental Health Counselor
  • Wichita Falls, TX
  • NPI 1710342258
  Medicare reassignment NPD Authorized official
• Bryan Wieck MD PA

  • Psychiatry Physician
  • Wichita Falls, TX
  • NPI 1346517182
  NPD (past)
• Invicta Services Group

  • Adolescent and Children Mental Health Clinic/Center
  • Fort Worth, TX
  • NPI 1033835251
  NPD (past)
• Rose Street Mental Health Care, LLP

  • Psychiatry Physician
  • Wichita Falls, TX
  • NPI 1760481709
  NPD (past)

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

{
    "created_epoch": "1236729600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719446400000",
    "number": "1215178926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4812 MAPLEWOOD AVE",
            "city": "WICHITA FALLS",
            "state": "TX",
            "postal_code": "763085312",
            "telephone_number": "940-432-8631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12650 N BEACH ST STE 114",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "762444245",
            "telephone_number": "940-432-8631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAW",
        "first_name": "MARTIN",
        "middle_name": "K",
        "name_prefix": "Mr.",
        "credential": "LPC, LMFT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-03-11",
        "last_updated": "2024-06-27",
        "certification_date": "2024-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "TX",
            "license": "63283",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200595101",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200595102",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Daphne Nizza Shaw, M.D.
• Jessica R Shaw, AGACNP-BC
• Kate M Shaw, LMSW
• Kelly L Shaw, RN
• Kymm Shaw, COTA
• Sarah Cornelia Shaw, DO
• Shuntoyia Yshay Shaw, PBT
• William J Shaw IV, PA-C
• Kathleen R Shea, LCSW
• Michael P Shea, O.D.

• Professional Counselor in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Professional Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.