MEDICARE: MR. GLENN L HAMMER M.S., 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	101Y00000X	Counselor	LPC804	WY
2	101YP2500X	Professional Counselor	LPC-804	WY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	312848	OTHER	WY	BLUE CROSS BLUE SHEILD

General Provider Information

NPI Number	:	1396846879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GLENN L HAMMER M.S., LPC

Provider Business Mailing Address
First Line	:	1575 N 4TH ST STE 103
Second Line	:
City	:	LARAMIE
State	:	WY
Zip	:	82072-2091
Country	:	US
Telephone Number	:	307-721-0700
Fax Number	:	307-721-1039

Provider Business Practice Location Address
First Line	:	1575 N 4TH ST STE 103
Second Line	:
City	:	LARAMIE
State	:	WY
Zip	:	82072-2091
Country	:	US
Telephone Number	:	307-721-0700
Fax Number	:	307-721-1039

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

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	09/06/2016

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