Provider Information for 1447792262
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ERIC SHIVELEY LPC
Sex: Male
NPI: 1447792262
Last Updated: 2021-05-12
Certification Date: 2021-05-12
Certification Date: 2021-05-12
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1447792262 | ||||||||
| Enumeration Date | 2016-11-10 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 8745 COUNTY ROAD 9 S ALAMOSA, CO 81101-9610 United States Phone: | Fax: | ||||||||
| Primary Practice Address | 8745 COUNTY ROAD 9 S ALAMOSA, CO 81101-9610 United States Phone: 719-589-3671 | Fax: | ||||||||
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