Healthcare Provider Details

I. General information

NPI: 1669961223
Provider Name (Legal Business Name): KEIRA LISBETH OLIVAS MA, LPC, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2018
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 MAPLE ST UNIT 102
FORT COLLINS CO
80521-2077
US

IV. Provider business mailing address

94 EVANS ST
SEVERANCE CO
80550-2642
US

V. Phone/Fax

Practice location:
  • Phone: 970-534-6877
  • Fax:
Mailing address:
  • Phone: 970-534-6877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0017461
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT.0002398
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: