Provider Demographics
NPI:1770964652
Name:SHIBA, LAUREL (PHD)
Entity type:Individual
Prefix:DR
First Name:LAUREL
Middle Name:
Last Name:SHIBA
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 1:5200 HAHNS PEAK DR
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-8852
Mailing Address - Country:US
Mailing Address - Phone:970-962-4900
Mailing Address - Fax:
Practice Address - Street 1:5200 HAHNS PEAK DR
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-8852
Practice Address - Country:US
Practice Address - Phone:970-962-4900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-16
Last Update Date:2020-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5340103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical