Provider Demographics
NPI:1972082303
Name:AEVUM, JOSHUA (LCSW)
Entity type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:
Last Name:AEVUM
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 EAST CHEYENNE MT. BLVD
Mailing Address - Street 2:STE C PMB #153
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-4570
Mailing Address - Country:US
Mailing Address - Phone:171-942-5502
Mailing Address - Fax:
Practice Address - Street 1:445 EAST CHEYENNE MT. BLVD
Practice Address - Street 2:STE C PMB #153
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-4570
Practice Address - Country:US
Practice Address - Phone:719-425-5026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-07
Last Update Date:2019-09-18
Deactivation Date:2019-01-09
Deactivation Code:
Reactivation Date:2019-09-18
Provider Licenses
StateLicense IDTaxonomies
COCSW.099235571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical