Provider Demographics
NPI:1215995154
Name:MAVES, PETER A (PHD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:A
Last Name:MAVES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1079 S HOVER ST STE 200
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-7924
Mailing Address - Country:US
Mailing Address - Phone:303-827-2485
Mailing Address - Fax:303-442-7312
Practice Address - Street 1:1079 S HOVER ST STE 200
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-7924
Practice Address - Country:US
Practice Address - Phone:303-827-2485
Practice Address - Fax:303-442-7312
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO995103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07009954Medicaid
CO86036Medicare ID - Type Unspecified