Provider Demographics
NPI:1861104176
Name:PEAVY, NATALIA ELIZABETH
Entity type:Individual
Prefix:
First Name:NATALIA
Middle Name:ELIZABETH
Last Name:PEAVY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12869 E CORNELL AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-3346
Mailing Address - Country:US
Mailing Address - Phone:203-988-1019
Mailing Address - Fax:
Practice Address - Street 1:12869 E CORNELL AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-3346
Practice Address - Country:US
Practice Address - Phone:203-988-1019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMFTC.0014401106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist