Provider Demographics
NPI:1851595474
Name:LOEUM-SHOTWELL, TEVEA (LPC, LAC, MAC, CCMHC)
Entity Type:Individual
Prefix:
First Name:TEVEA
Middle Name:
Last Name:LOEUM-SHOTWELL
Suffix:
Gender:F
Credentials:LPC, LAC, MAC, CCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMR 402
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09180-0402
Mailing Address - Country:US
Mailing Address - Phone:314-590-7877
Mailing Address - Fax:
Practice Address - Street 1:CMR 402
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09180-0402
Practice Address - Country:US
Practice Address - Phone:314-590-7877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CO620101YA0400X
COCACIII-6910101YA0400X
CO225642101YM0800X
COLPC-5389101YM0800X
CO5389101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health