=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215476965
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CYNTHIA RUTH COVELL LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/14/2017
-----------------------------------------------------
Last Update Date | 02/14/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13100 E COLFAX AVE
-----------------------------------------------------
City | AURORA
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80011-5517
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-777-7468
-----------------------------------------------------
Fax | 720-777-7380
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3527 N MARION ST
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80205-3956
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-564-3520
-----------------------------------------------------
Fax | 720-777-7380
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 744
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------