MEDICARE: MR. JON C SMITH

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	101YP2500X	Professional Counselor	LPC.0012608	CO

General Provider Information

NPI Number	:	1366751596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JON C SMITH

Provider Business Mailing Address
First Line	:	7200 E DRY CREEK RD
Second Line	:	SUITE E-207
City	:	CENTENNIAL
State	:	CO
Zip	:	80112-2537
Country	:	US
Telephone Number	:	303-660-5397
Fax Number	:

Provider Business Practice Location Address
First Line	:	7200 E DRY CREEK RD
Second Line	:	SUITE E-207
City	:	CENTENNIAL
State	:	CO
Zip	:	80112-2537
Country	:	US
Telephone Number	:	303-660-5397
Fax Number	:

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

Provider Enumeration Date	:	10/05/2010
Last Update Date	:	05/21/2016

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