MEDICARE: JENNIFER C SHIVEY LPC, RPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	11965	CO

General Provider Information

NPI Number	:	1760767602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER C SHIVEY LPC, RPT

Provider Business Mailing Address
First Line	:	1660 S ALBION ST STE 415
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80222-4043
Country	:	US
Telephone Number	:	720-531-3917
Fax Number	:

Provider Business Practice Location Address
First Line	:	1660 S ALBION ST STE 415
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80222-4043
Country	:	US
Telephone Number	:	720-531-3917
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2011
Last Update Date	:	06/11/2019

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