Provider Demographics
NPI:1225765423
Name:PETER A. MAVES, PH.D, PLLC
Entity Type:Organization
Organization Name:PETER A. MAVES, PH.D, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAVES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:303-827-2485
Mailing Address - Street 1:1079 S HOVER ST STE 200
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-7924
Mailing Address - Country:US
Mailing Address - Phone:303-827-2485
Mailing Address - Fax:
Practice Address - Street 1:1079 S HOVER ST STE 200
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-7924
Practice Address - Country:US
Practice Address - Phone:303-827-2485
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-07
Last Update Date:2022-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty