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Jacob R Shaw
Peer Specialist in Basin, Wyoming
NPI 1396513719

Jacob R Shaw is a Peer Specialist based in Lovell, WY. Jacob R Shaw practices in Basin, WY. The NPI Number for Jacob R Shaw is 1396513719 and holds a License No. 143 (Wyoming).

The current practice location address for Jacob R Shaw is 116 South 3Rd Street, Basin, WY and can be reached out via phone at 307-568-2020. You can also correspond with Jacob R Shaw through the mailing address at 1114 LANE 12, LOVELL, WY - 82431-9555 (mailing address contact number: 307-548-6543).

Location: 116 South 3Rd Street, Basin, WY, 82431-9555
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1396513719
Provider Name
Jacob R Shaw
Credential
Provider Entity Type
Individual
Gender
Male
Address
116 South 3Rd Street, Basin, WY, 82431-9555
Phone Number
307-568-2020
Fax Number
Provider Enumeration Date
12/14/2023
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
116 South 3Rd Street
City
Basin
State
Wyoming
Zip
82410
Phone Number
307-568-2020
Fax Number
person
Provider Business Mailing Address Details
Address
116 South 3Rd Street
City
Basin
State
Wyoming
Zip
82410
Phone Number
307-568-2020
Fax Number
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Peer Specialist
Speciality
-
Taxonomy
175T00000X
License No.
143 (Wyoming)
Definition
Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority.
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