Provider Demographics
NPI:1073717203
Name:HOMER, LAURIE RACHAEL (MS, NCC, PPC)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:RACHAEL
Last Name:HOMER
Suffix:
Gender:F
Credentials:MS, NCC, PPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 S 23RD ST
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-4911
Mailing Address - Country:US
Mailing Address - Phone:307-721-9099
Mailing Address - Fax:
Practice Address - Street 1:ALPENGLOW WELLNESS, INC., NORTHGATE OFFICE COMPLEX
Practice Address - Street 2:SUITE 115, 1465 NORTH 4TH ST.,
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82073
Practice Address - Country:US
Practice Address - Phone:307-721-9099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPPC-351101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional