MEDICARE: JOCELYN BROOKS MAVEC DOVE MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12259	OTHER	CO	DEPARTMENT OF REGULATORY AGENCIES

General Provider Information

NPI Number	:	1346500931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOCELYN BROOKS MAVEC DOVE MA

Provider Business Mailing Address
First Line	:	1302 S SHIELDS ST # A 1/3
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80521-4801
Country	:	US
Telephone Number	:	970-232-4242
Fax Number	:

Provider Business Practice Location Address
First Line	:	1302 S SHIELDS ST # A 1/3
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80521-4801
Country	:	US
Telephone Number	:	970-232-4242
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2012
Last Update Date	:	05/17/2012

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