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
1	101YP2500X	Professional Counselor	PPC-351	WY

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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