Provider Demographics
NPI:1043656259
Name:CAVALLI, SHAUNA J (MA)
Entity Type:Individual
Prefix:
First Name:SHAUNA
Middle Name:J
Last Name:CAVALLI
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 COFFMAN ST
Mailing Address - Street 2:SUITE 114
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-5451
Mailing Address - Country:US
Mailing Address - Phone:720-557-7720
Mailing Address - Fax:
Practice Address - Street 1:500 COFFMAN ST
Practice Address - Street 2:SUITE 114
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-5451
Practice Address - Country:US
Practice Address - Phone:720-557-7720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-14
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health