Provider Demographics
NPI:1720324601
Name:GARRETT, SHAUNDIVA LYNN (LPC)
Entity type:Individual
Prefix:
First Name:SHAUNDIVA
Middle Name:LYNN
Last Name:GARRETT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17197 CORNERSTONE DR
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-9151
Mailing Address - Country:US
Mailing Address - Phone:720-284-8626
Mailing Address - Fax:
Practice Address - Street 1:17197 CORNERSTONE DR
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-9151
Practice Address - Country:US
Practice Address - Phone:720-284-8626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-20
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CO0013994101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health