MEDICARE: MS. KRISTIN ST. LAURENT WAGNER LCPC

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	1539	MT

General Provider Information

NPI Number	:	1992096812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KRISTIN ST. LAURENT WAGNER LCPC

Provider Business Mailing Address
First Line	:	225 N 23RD ST
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59101-2223
Country	:	US
Telephone Number	:	406-252-1177
Fax Number	:

Provider Business Practice Location Address
First Line	:	225 N 23RD ST
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59101-2223
Country	:	US
Telephone Number	:	406-252-1177
Fax Number	:

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

Provider Enumeration Date	:	04/26/2011
Last Update Date	:	04/26/2011

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