MEDICARE: MS. LAURIE M. BRANCH M.A., L.P.C., CACIII

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	LPC 1434	CO

General Provider Information

NPI Number	:	1629254198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAURIE M. BRANCH M.A., L.P.C., CACIII

Provider Business Mailing Address
First Line	:	5815 ORCHARD CREEK LN
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80301-5821
Country	:	US
Telephone Number	:	303-444-7256
Fax Number	:	303-444-7439

Provider Business Practice Location Address
First Line	:	100 ARAPAHOE AVE STE 7
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80302-5862
Country	:	US
Telephone Number	:	303-444-7256
Fax Number	:	303-444-7439

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

Provider Enumeration Date	:	01/15/2008
Last Update Date	:	01/15/2008

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