MEDICARE: CHARLES A LAUREL MS

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	101YM0800X	Mental Health Counselor	068.0101693	VT

General Provider Information

NPI Number	:	1225385552
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES A LAUREL MS

Provider Business Mailing Address
First Line	:	24 EAST-WEST RD
Second Line	:
City	:	E DUMMERSTON
State	:	VT
Zip	:	05346-9635
Country	:	US
Telephone Number	:	802-258-8313
Fax Number	:

Provider Business Practice Location Address
First Line	:	24 EAST-WEST RD
Second Line	:
City	:	EAST DUMMERSTON
State	:	VT
Zip	:	05346-9635
Country	:	US
Telephone Number	:	802-258-8313
Fax Number	:

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

Provider Enumeration Date	:	08/06/2012
Last Update Date	:	12/26/2023

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