Provider Demographics
NPI:1033901210
Name:PENBERTHY, SHIVANI EVE (MA, LPCC)
Entity type:Individual
Prefix:
First Name:SHIVANI
Middle Name:EVE
Last Name:PENBERTHY
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:EVE
Other - Middle Name:
Other - Last Name:PENBERTHY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LPCC
Mailing Address - Street 1:55 SPRING DALE PL
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80504-1236
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:421 21ST AVE
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-1469
Practice Address - Country:US
Practice Address - Phone:415-446-8746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-21
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0020917101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health