Healthcare Provider Details

I. General information

NPI: 1154242246
Provider Name (Legal Business Name): BRENDA SUE KING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 E 3RD ST
CASPER WY
82601-3237
US

IV. Provider business mailing address

934 COUNTRY CLUB RD
CASPER WY
82609-2667
US

V. Phone/Fax

Practice location:
  • Phone: 307-462-4876
  • Fax:
Mailing address:
  • Phone: 719-429-9999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberCSSP-19
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: