MEDICARE: MS. YURI EDNA FREEMAN MA

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	LPC 928	WY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	313171	OTHER	WY	BS

General Provider Information

NPI Number	:	1588662696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. YURI EDNA FREEMAN MA

Provider Business Mailing Address
First Line	:	350 CITY VIEW DR STE 206
Second Line	:
City	:	EVANSTON
State	:	WY
Zip	:	82930-5326
Country	:	US
Telephone Number	:	307-789-7915
Fax Number	:	307-778-3944

Provider Business Practice Location Address
First Line	:	350 CITY VIEW DR STE 206
Second Line	:
City	:	EVANSTON
State	:	WY
Zip	:	82930-5326
Country	:	US
Telephone Number	:	307-789-7915
Fax Number	:

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

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	04/10/2019

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