MEDICARE: MARY J ADAMS LMFT, LAT

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	106H00000X	Marriage & Family Therapist	076	WY
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	252	WY

General Provider Information

NPI Number	:	1932390382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY J ADAMS LMFT, LAT

Provider Business Mailing Address
First Line	:	721 EAST LINCOLNWAY
Second Line	:
City	:	CHEYENNE
State	:	WY
Zip	:	82001-4703
Country	:	US
Telephone Number	:	307-220-0485
Fax Number	:	307-638-2104

Provider Business Practice Location Address
First Line	:	721 E LINCOLNWAY
Second Line	:
City	:	CHEYENNE
State	:	WY
Zip	:	82001-4703
Country	:	US
Telephone Number	:	307-220-0485
Fax Number	:	307-638-2104

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

Provider Enumeration Date	:	08/08/2007
Last Update Date	:	12/01/2011

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