Basic Information
| Provider Information | |||||||||
| NPI: | 1366652653 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCOVEL | ||||||||
| FirstName: | DAWN | ||||||||
| MiddleName: | ANGELEN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 559 VINCENT ST | ||||||||
| Address2: | ATTN: 21MDOS/SGOH | ||||||||
| City: | PETERSON AFB | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195567804 | ||||||||
| FaxNumber: | 7195567399 | ||||||||
| Practice Location | |||||||||
| Address1: | 559 VINCENT ST | ||||||||
| Address2: | ATTN: 21MDOS/SGOH | ||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809141541 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195567804 | ||||||||
| FaxNumber: | 7195567399 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2007 | ||||||||
| LastUpdateDate: | 10/29/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 1385 | CO | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.