Provider Demographics
NPI:1538284518
Name:SMITH, ROSE MARY (LPC)
Entity Type:Individual
Prefix:MRS
First Name:ROSE
Middle Name:MARY
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1870 DUBLIN BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-1294
Mailing Address - Country:US
Mailing Address - Phone:719-963-7477
Mailing Address - Fax:719-573-5448
Practice Address - Street 1:1870 DUBLIN BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-1294
Practice Address - Country:US
Practice Address - Phone:719-963-7477
Practice Address - Fax:719-573-5448
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3202101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO532738Medicaid