Healthcare Provider Details

I. General information

NPI: 1588389209
Provider Name (Legal Business Name): MARIAH NICOLE SEVERUD BA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2022
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12191 W 64TH AVE STE 203
ARVADA CO
80004-4030
US

IV. Provider business mailing address

12191 W 64TH AVE STE 203
ARVADA CO
80004-4030
US

V. Phone/Fax

Practice location:
  • Phone: 720-340-1678
  • Fax:
Mailing address:
  • Phone: 720-340-1678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: