Michael M Shaw, PH.D, LMHC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

MH8792 Issued in FL

Practice address

2156 Sequoia CT
Jacksonville, FL 32218-0633

Phone

(904) 868-0534

Fax

(904) 868-0534

NPI assigned

Feb 20, 2007

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 1

Medicare fee-for-service enrollment

Enrolled in MA, FL2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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.

• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  MA

  Medicare reassignment NPD

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

{
    "created_epoch": "1171929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727568000000",
    "number": "1659416626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2156 SEQUOIA CT",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322180633",
            "telephone_number": "904-868-0534",
            "fax_number": "904-868-0534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2156 SEQUOIA CT",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322180633",
            "telephone_number": "904-868-0534",
            "fax_number": "904-868-0534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAW",
        "first_name": "MICHAEL",
        "middle_name": "M",
        "credential": "PH.D, LMHC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-20",
        "last_updated": "2024-09-29",
        "certification_date": "2024-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH8792",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "767840100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Autum Shaw, CRNA
• Chad P Shaw, DC
• Faith Shaw
• Lindsay J Shaw, FNP-BC
• Mallory Lynn Shaw, LMSW
• Rachel Shaw, DNP, FNP-BC
• Vanessa Lynne Shaw, APRN
• Shawn Davis Healthcare LLC
• Shaya Medical PC Inc
• Wissam M Shaya, M.D.

• Mental Health Counselor in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Mental Health Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.