MEDICARE: MRS. ROSE MARY SMITH LPC

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	101YM0800X	Mental Health Counselor	3202	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538284518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ROSE MARY SMITH LPC

Provider Business Mailing Address
First Line	:	1870 DUBLIN BLVD
Second Line	:	SUITE B
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-1294
Country	:	US
Telephone Number	:	719-963-7477
Fax Number	:	719-573-5448

Provider Business Practice Location Address
First Line	:	1870 DUBLIN BLVD
Second Line	:	SUITE B
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-1294
Country	:	US
Telephone Number	:	719-963-7477
Fax Number	:	719-573-5448

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

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	07/09/2007

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