Healthcare Provider Details

I. General information

NPI: 1376454124
Provider Name (Legal Business Name): GAVIN'S WINGS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2026
Last Update Date: 09/12/2026
Certification Date: 09/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 E 2ND ST STE 305
CASPER WY
82601-2539
US

IV. Provider business mailing address

2110 MANDAN TRL
BAR NUNN WY
82601-8901
US

V. Phone/Fax

Practice location:
  • Phone: 307-315-4474
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: BRANDI J KING
Title or Position: OWNER
Credential: LPC
Phone: 307-763-6688