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NPI Code Detail

MEDICARE: MS. LAURIE RACHAEL HOMER M.S., N.C.C., P.P.C.

MEDICARE: MS. LAURIE RACHAEL HOMER M.S., N.C.C., P.P.C.
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
1101YP2500XProfessional CounselorPPC-351WY

General Provider Information

NPI Number : 1073717203
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LAURIE RACHAEL HOMER M.S., N.C.C., P.P.C.
Provider Business Mailing Address
First Line : 702 S 23RD ST
Second Line :
City : LARAMIE
State : WY
Zip : 82070-4911
Country : US
Telephone Number : 307-721-9099
Fax Number :
Provider Business Practice Location Address
First Line : ALPENGLOW WELLNESS, INC., NORTHGATE OFFICE COMPLEX
Second Line : SUITE 115, 1465 NORTH 4TH ST.,
City : LARAMIE
State : WY
Zip : 82073
Country : US
Telephone Number : 307-721-9099
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2007
Last Update Date : 07/08/2007

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