Healthcare Provider Details

I. General information

NPI: 1346405016
Provider Name (Legal Business Name): GARY R KING LPC 1227
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2008
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4025 RAWLINS ST
CHEYENNE WY
82001-1900
US

IV. Provider business mailing address

4025 RAWLINS ST
CHEYENNE WY
82001-1900
US

V. Phone/Fax

Practice location:
  • Phone: 307-426-4797
  • Fax: 307-426-4799
Mailing address:
  • Phone: 307-389-2566
  • Fax: 307-426-4799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-1227
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: