MEDICARE: MR. GEORGE EDWARD BROWN MED, LPC, CRT

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-200	WY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	BRO314530	OTHER	WY	BCBS OF WYOMING

General Provider Information

NPI Number	:	1811192974
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GEORGE EDWARD BROWN MED, LPC, CRT

Provider Business Mailing Address
First Line	:	800 WERNER CT
Second Line	:	SUITE 235
City	:	CASPER
State	:	WY
Zip	:	82601-1326
Country	:	US
Telephone Number	:	307-233-4210
Fax Number	:	307-233-4213

Provider Business Practice Location Address
First Line	:	800 WERNER CT
Second Line	:	SUITE 235
City	:	CASPER
State	:	WY
Zip	:	82601-1326
Country	:	US
Telephone Number	:	307-233-4210
Fax Number	:	307-233-4213

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

Provider Enumeration Date	:	06/19/2007
Last Update Date	:	07/08/2007

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