MEDICARE: LARIVIERE CREATIVE COUNSELING

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

General Provider Information

NPI Number	:	1871117374
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LARIVIERE CREATIVE COUNSELING

Provider Business Mailing Address
First Line	:	5145 N ACADEMY BLVD STE 110
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-4051
Country	:	US
Telephone Number	:	719-425-8911
Fax Number	:

Provider Business Practice Location Address
First Line	:	5145 N ACADEMY BLVD STE 110
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-4051
Country	:	US
Telephone Number	:	719-425-8911
Fax Number	:

Authorized Official
Title or Position	:	LICENSED PROFESSIONAL COUNSELOR
Name	:	MS. NANCY LARIVIERE
Credential	:	LPC
Telephone Number	:	719-425-8911

Provider Enumeration Date	:	06/01/2020
Last Update Date	:	06/16/2020

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