Provider Demographics
NPI:1417336470
Name:CG MENTAL HEALTH INC.
Entity Type:Organization
Organization Name:CG MENTAL HEALTH INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:D
Authorized Official - Last Name:GAUGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-254-1818
Mailing Address - Street 1:PO BOX 427
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:WY
Mailing Address - Zip Code:82435-0427
Mailing Address - Country:US
Mailing Address - Phone:307-254-1818
Mailing Address - Fax:
Practice Address - Street 1:335 N GILBERT ST
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:WY
Practice Address - Zip Code:82435-2023
Practice Address - Country:US
Practice Address - Phone:307-254-1818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-23
Last Update Date:2015-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLCSW-557251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health