Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Jack William Shaw, EDD, LMHC

Individual provider Addiction (Substance Use Disorder) Counselor · NPI 1124623319

Dr. Jack William Shaw, EDD, LMHC is a Mental Health Counselor in St Petersburg, Florida. Qualified in 2018, 8 years ago. Licensed in Florida.

Years since qualifying
8
Licensed in
FL
In the registry since
2020
Specialties on file
2
What do these letters mean?
EDD — Doctor of Education
A doctorate in education.
LMHC — Licensed Mental Health Counselor
A licensed mental health counsellor; the title used in Florida, New York and Washington among others.

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Practice location Address checks out

1735 Dr Mlk Jr St S
St Petersburg, FL 33705-2547
Phone: (727) 502-0188
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Mental Health Counselor (primary) Taxonomy 101YM0800X · Licence MH21197 (FL)
Addiction (Substance Use Disorder) Counselor Taxonomy 101YA0400X · Licence MCAP100243 (FL)

Record details

NPI number1124623319
Entity typeIndividual (Type 1)
GenderMale
Credentials EDD , LMHC
Sole proprietorNo
NPI enumeratedDecember 3, 2020
Last updated in NPPESNovember 2, 2022
Certification dateOctober 31, 2022

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyMENTAL HEALTH COUNSELOR
Medical schoolOTHER
Graduated 2018 (8 years in practice)
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

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