MEDICARE: MS. AMY MORAN M.S.

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	1066	WY

General Provider Information

NPI Number	:	1821035866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMY MORAN M.S.

Provider Business Mailing Address
First Line	:	1158 FRONTERA DR
Second Line	:
City	:	LARAMIE
State	:	WY
Zip	:	82072-5024
Country	:	US
Telephone Number	:	307-760-2771
Fax Number	:

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	:	307-760-2771
Fax Number	:

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

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	12/01/2016

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