Provider Demographics
NPI:1851024673
Name:CREAVEN, SHYAMAA MARIE (LPC)
Entity Type:Individual
Prefix:DR
First Name:SHYAMAA
Middle Name:MARIE
Last Name:CREAVEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1652 BRADLEY CT
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80305-7300
Mailing Address - Country:US
Mailing Address - Phone:720-232-6399
Mailing Address - Fax:
Practice Address - Street 1:1652 BRADLEY CT
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80305-7300
Practice Address - Country:US
Practice Address - Phone:720-232-6399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-08
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5699101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE