Provider Demographics
NPI:1457444077
Name:SHIVELY, ROYACE ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROYACE
Middle Name:ANN
Last Name:SHIVELY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1571 WSC
Mailing Address - Street 2:BRIGHAM YOUNG UNIVERSITY
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84602
Mailing Address - Country:US
Mailing Address - Phone:801-422-3035
Mailing Address - Fax:801-422-0173
Practice Address - Street 1:1571 WSC
Practice Address - Street 2:BRIGHAM YOUNG UNIVERSITY
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84602
Practice Address - Country:US
Practice Address - Phone:801-422-3035
Practice Address - Fax:801-422-0173
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT117606-2501103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling