Provider Demographics
NPI:1467539098
Name:KRAVETZ, MARSHA L (LMFT, LPC)
Entity Type:Individual
Prefix:
First Name:MARSHA
Middle Name:L
Last Name:KRAVETZ
Suffix:
Gender:F
Credentials:LMFT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 DEPOT HILL RD STE D
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-6741
Mailing Address - Country:US
Mailing Address - Phone:970-368-3282
Mailing Address - Fax:
Practice Address - Street 1:1006 DEPOT HILL RD STE D
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-6741
Practice Address - Country:US
Practice Address - Phone:970-368-3282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4188106H00000X
CO5250101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX028547001Medicaid
TX124221OtherSUPERIOR PIN
TX223453OtherPHCS PIN
TX00G981OtherBCBSTX GRP PIN
1336198894OtherGRP NPI NUMBER
TX2219619OtherFIRSTHEALTH PIN
TX83360LOtherBCBSTX IND PIN
TX75205167613OtherPBH PIN
TX10027416OtherAMERIGROUP PIN