MEDICARE: KEIRA LISBETH OLIVAS MA, LPC, LMFT

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	101YP2500X	Professional Counselor	LPC.0017461	CO
2	106H00000X	Marriage & Family Therapist	MFT.0002398	CO

General Provider Information

NPI Number	:	1669961223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEIRA LISBETH OLIVAS MA, LPC, LMFT

Provider Business Mailing Address
First Line	:	94 EVANS ST
Second Line	:
City	:	SEVERANCE
State	:	CO
Zip	:	80550-2642
Country	:	US
Telephone Number	:	970-543-6877
Fax Number	:

Provider Business Practice Location Address
First Line	:	204 MAPLE ST UNIT 102
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80521-2077
Country	:	US
Telephone Number	:	970-543-6877
Fax Number	:

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

Provider Enumeration Date	:	05/08/2018
Last Update Date	:	06/02/2026

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