MEDICARE: MR. BROOKS WILLIAM BAER LCPC

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	776	MT

General Provider Information

NPI Number	:	1003821976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BROOKS WILLIAM BAER LCPC

Provider Business Mailing Address
First Line	:	PO BOX 12
Second Line	:
City	:	LIBERTY LAKE
State	:	WA
Zip	:	99019-0012
Country	:	US
Telephone Number	:	406-543-7271
Fax Number	:

Provider Business Practice Location Address
First Line	:	902 N ORANGE ST
Second Line	:	SUITE 102
City	:	MISSOULA
State	:	MT
Zip	:	59802-2928
Country	:	US
Telephone Number	:	406-327-3034
Fax Number	:	406-327-3385

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

Provider Enumeration Date	:	07/29/2006
Last Update Date	:	02/05/2016

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Directions to “ MR. BROOKS WILLIAM BAER LCPC” Practice Location

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