Provider Demographics
NPI:1821506213
Name:SHIVES, USTINA TREBER (MA LPC)
Entity Type:Individual
Prefix:MS
First Name:USTINA
Middle Name:TREBER
Last Name:SHIVES
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 1:808 W LAKE LANSING RD STE 200
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-6322
Mailing Address - Country:US
Mailing Address - Phone:260-577-3134
Mailing Address - Fax:
Practice Address - Street 1:808 W LAKE LANSING RD STE 200
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-6322
Practice Address - Country:US
Practice Address - Phone:260-577-3134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-19
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401222360101YM0800X
MI6301017351103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health