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General NPI Number Information
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NPI Number | 1073717203
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Entity Type | Individual
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Provider Name | LAURIE RACHAEL HOMER M.S., N.C.C., P.P.C.
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Gender | Female
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Dates
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Enumeration Date | 06/12/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | ALPENGLOW WELLNESS, INC., NORTHGATE OFFICE COMPLEX SUITE 115, 1465 NORTH 4TH ST.,
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City | LARAMIE
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State | WY
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Zip | 82073
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Country | US
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Telephone | 307-721-9099
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Fax |
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Provider Business Mailing Address
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Address Line | 702 S 23RD ST
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City | LARAMIE
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State | WY
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Zip | 82070-4911
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Country | US
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Telephone | 307-721-9099
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PPC-351
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License Number State | WY
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