MEDICARE: HEIDI CHRISTINE SOMERS M.A., L.M.F.T

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	106H00000X	Marriage & Family Therapist	214	WY

General Provider Information

NPI Number	:	1700341914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEIDI CHRISTINE SOMERS M.A., L.M.F.T

Provider Business Mailing Address
First Line	:	PO BOX 14865
Second Line	:
City	:	JACKSON
State	:	WY
Zip	:	83002-4865
Country	:	US
Telephone Number	:	307-413-4334
Fax Number	:

Provider Business Practice Location Address
First Line	:	330 N GLENWOOD ST
Second Line	:
City	:	JACKSON
State	:	WY
Zip	:	83001-8765
Country	:	US
Telephone Number	:	307-413-4334
Fax Number	:

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

Provider Enumeration Date	:	02/01/2019
Last Update Date	:	02/01/2019

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