Provider Demographics
NPI:1013360478
Name:JENNIFER SHIVEY, LLC
Entity Type:Organization
Organization Name:JENNIFER SHIVEY, LLC
Other - Org Name:REALISTIC SERENITY COUNSELING AND MEDIATION SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/THERPAIST
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIVEY
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, RPT
Authorized Official - Phone:303-523-7594
Mailing Address - Street 1:1660 S ALBION ST
Mailing Address - Street 2:SUITE 1026
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-4008
Mailing Address - Country:US
Mailing Address - Phone:303-523-7594
Mailing Address - Fax:
Practice Address - Street 1:1660 S ALBION ST
Practice Address - Street 2:SUITE 1026
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-4008
Practice Address - Country:US
Practice Address - Phone:303-523-7594
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11965101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty