Provider Demographics
NPI:1467503649
Name:PEVNY, BARBARA DONICA (MA, LPC)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:DONICA
Last Name:PEVNY
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2420 DELWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-4540
Mailing Address - Country:US
Mailing Address - Phone:970-385-5992
Mailing Address - Fax:970-382-9210
Practice Address - Street 1:185 SUTTLE ST
Practice Address - Street 2:SUITE NN
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81303-3410
Practice Address - Country:US
Practice Address - Phone:970-385-5992
Practice Address - Fax:970-382-9210
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO919101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO163501Medicaid