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General NPI Number Information
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NPI Number | 1417336470
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Entity Type | Organization
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Legal Business Name | CG MENTAL HEALTH INC.
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Dates
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Enumeration Date | 05/23/2015
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Last Update Date | 05/23/2015
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Provider Practice Location Address
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Address Line | 335 N GILBERT ST
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City | POWELL
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State | WY
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Zip | 82435-2023
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Country | US
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Telephone | 307-254-1818
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 427
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City | POWELL
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State | WY
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Zip | 82435-0427
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Country | US
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Telephone | 307-254-1818
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHRISTOPHER D. GAUGER
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Credential |
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Telephone | 307-254-1818
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | LCSW-557
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License Number State | WY
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