=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568736049
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COVEY AND SMITH LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/01/2012
-----------------------------------------------------
Last Update Date | 03/01/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 402 W 4TH S
-----------------------------------------------------
City | REXBURG
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83440-2640
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-313-7464
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 402 W 4TH S
-----------------------------------------------------
City | REXBURG
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83440-2640
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-313-7464
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-OWNER
-----------------------------------------------------
Name | ROSEMARY SMITH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 208-313-7464
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------