Provider Demographics
NPI:1003352972
Name:MARVIN, PAIGE MICHAL
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:MICHAL
Last Name:MARVIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PAIGE
Other - Middle Name:MICHAL
Other - Last Name:BRISTOL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 193
Mailing Address - Street 2:
Mailing Address - City:COLLBRAN
Mailing Address - State:CO
Mailing Address - Zip Code:81624-0193
Mailing Address - Country:US
Mailing Address - Phone:970-487-0259
Mailing Address - Fax:
Practice Address - Street 1:4051 PINION ST.
Practice Address - Street 2:
Practice Address - City:COLLBRAN
Practice Address - State:CO
Practice Address - Zip Code:81624-0193
Practice Address - Country:US
Practice Address - Phone:970-487-0259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-16
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0015922101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional