Individual
EILEEN MARIE GAVAGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A.
Contact information
Practice address
623 W 20TH ST, CHEYENNE, WY 82001-3501
(307) 640-0301
Mailing address
PO BOX 1842, CHEYENNE, WY 82003-1842
(307) 640-0301
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
PPC-851
WY
101YM0800X
Mental Health Counselor
Primary
LPC-1551
WY
Other
Enumeration date
08/22/2014
Last updated
02/10/2023
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