MEDICARE: DANA C AVEY LMFT

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	106H00000X	Marriage & Family Therapist	0001207	CO
2	106H00000X	Marriage & Family Therapist	001235	GA

General Provider Information

NPI Number	:	1811147200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANA C AVEY LMFT

Provider Business Mailing Address
First Line	:	1301 S 8TH ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80905-7335
Country	:	US
Telephone Number	:	866-413-2279
Fax Number	:

Provider Business Practice Location Address
First Line	:	1301 S 8TH ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80905-7335
Country	:	US
Telephone Number	:	866-413-2279
Fax Number	:

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

Provider Enumeration Date	:	09/23/2008
Last Update Date	:	10/30/2016

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