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General NPI Number Information
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NPI Number | 1376454124
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Entity Type | Organization
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Legal Business Name | GAVIN'S WINGS, LLC
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Dates
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Enumeration Date | 09/12/2026
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Last Update Date | 09/12/2026
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Provider Practice Location Address
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Address Line | 232 E 2ND ST STE 305
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City | CASPER
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State | WY
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Zip | 82601-2539
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Country | US
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Telephone | 307-315-4474
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Fax |
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Provider Business Mailing Address
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Address Line | 2110 MANDAN TRL
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City | BAR NUNN
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State | WY
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Zip | 82601-8901
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRANDI J KING
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Credential | LPC
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Telephone | 307-763-6688
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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