MEDICARE: MR. GREGARY E MEREDITH LPC

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	WYOMING PPC #534	WY
2	101YP2500X	Professional Counselor	LPC-1322	WY

General Provider Information

NPI Number	:	1902186711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GREGARY E MEREDITH LPC

Provider Business Mailing Address
First Line	:	PO BOX 1234
Second Line	:
City	:	RIVERTON
State	:	WY
Zip	:	82501-0156
Country	:	US
Telephone Number	:	307-857-3111
Fax Number	:	307-857-3848

Provider Business Practice Location Address
First Line	:	902 NORTH 8TH WEST STREET
Second Line	:
City	:	RIVERTON
State	:	WY
Zip	:	82501-2332
Country	:	US
Telephone Number	:	307-857-3111
Fax Number	:	307-857-3848

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

Provider Enumeration Date	:	08/24/2011
Last Update Date	:	06/24/2014

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