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NPI Code Detail

MEDICARE: EILEEN MARIE GAVAGAN M.A.

MEDICARE: EILEEN MARIE GAVAGAN M.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselorPPC-851WY
2101YM0800XMental Health CounselorLPC-1551WY

General Provider Information

NPI Number : 1164821476
Entity Type Code : Individual
Provider Name (Legal Business Name) : EILEEN MARIE GAVAGAN M.A.
Provider Business Mailing Address
First Line : PO BOX 1842
Second Line :
City : CHEYENNE
State : WY
Zip : 82003-1842
Country : US
Telephone Number : 307-640-0301
Fax Number :
Provider Business Practice Location Address
First Line : 623 W 20TH ST
Second Line :
City : CHEYENNE
State : WY
Zip : 82001-3501
Country : US
Telephone Number : 307-640-0301
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/22/2014
Last Update Date : 02/10/2023

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