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DR. JACK WILLIAM SHAW ED.D., LMHC
NPI 1124623319
Counselor - Mental Health in St Petersburg, FL

Active since December 03, 2020PECOS Enrolled
1735 DR MLK JR STREET SOUTH, ST PETERSBURG, FL 33705(727) 502-0188 Get Directions Write a Review

NPPES record last updated: November 2, 2022. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Nov 2, 2022, Dec 3, 2020 (2 updates tracked since 2020).

About Dr. Jack William Shaw Ed.d., Lmhc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. JACK WILLIAM SHAW ED.D., LMHC (NPI 1124623319) is an individual mental health provider in St Petersburg, Florida, licensed in Florida (MH21197) and active in the NPI registry since December 2020. He is enrolled in Medicare PECOS and is a graduate of Other (2018).

NPPES Registry Identity

NPI1124623319
Entity TypeIndividualMale
Primary Taxonomy101YM0800X
Provider Legal NameDR. JACK WILLIAM SHAWCredential: ED.D., LMHC
Location Address1735 DR MLK JR STREET SOUTHSt Petersburg, FL 33705-2547
Mailing Address7780 49th St N # 254Pinellas Park, FL 33781-3440
Phone(727) 502-0188
Sole ProprietorNo
Medical School CMSOtherGraduated 2018
Enumeration DateDecember 3, 2020
Last NPPES UpdateNovember 2, 20222 updates tracked since enumeration
NPPES CertifiedOctober 31, 2022
✔ NPI 1124623319 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers
Taxonomy Code101YM0800X
License✔ Licensed in FL · MH21197
Also ListedCounselor · Addiction (Substance Use Disorder)Taxonomy 101YA0400X · License MCAP100243 (FL)
1735 DR MLK JR STREET SOUTH, St Petersburg, FL 33705
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Jack William Shaw Ed.d., Lmhc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID6305321456
PECOS Enrollment IDI20260326003601
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jack Shaw's NPI number?

The NPI number for Jack Shaw is 1124623319. It was assigned to this individual provider in the NPPES registry on December 3, 2020.

Where is Jack Shaw located?

Jack Shaw practices at 1735 Dr Mlk Jr Street South, St Petersburg, FL 33705. The listed phone number is (727) 502-0188.

What is Jack Shaw's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

Is Jack Shaw enrolled in Medicare?

Yes. Jack Shaw is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Jack Shaw was last updated on November 2, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.