MEDICARE: DEBORAH HARPER MSW, LAT, LCSW

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	311	WY
2	1041C0700X	Clinical Social Worker	633	WY

General Provider Information

NPI Number	:	1720064728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH HARPER MSW, LAT, LCSW

Provider Business Mailing Address
First Line	:	1263 N 15TH ST
Second Line	:
City	:	LARAMIE
State	:	WY
Zip	:	82072-2343
Country	:	US
Telephone Number	:	307-745-8915
Fax Number	:	307-745-8761

Provider Business Practice Location Address
First Line	:	1263 N 15TH ST
Second Line	:
City	:	LARAMIE
State	:	WY
Zip	:	82072-2343
Country	:	US
Telephone Number	:	307-745-8915
Fax Number	:	307-745-8761

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

Provider Enumeration Date	:	12/21/2005
Last Update Date	:	04/05/2011

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