Healthcare Provider Details

I. General information

NPI: 1861065864
Provider Name (Legal Business Name): DEVIN HAVENER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2021
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5600 ARAPAHOE AVE STE 100
BOULDER CO
80303-1359
US

IV. Provider business mailing address

239 SHOVELER WAY
JOHNSTOWN CO
80534-9572
US

V. Phone/Fax

Practice location:
  • Phone: 303-501-0067
  • Fax:
Mailing address:
  • Phone: 319-213-0278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0021214
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: