Provider Demographics
NPI:1801869169
Name:WITH EAGLES WINGS
Entity type:Organization
Organization Name:WITH EAGLES WINGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF WITH EAGLES WINGS
Authorized Official - Prefix:DR
Authorized Official - First Name:LEON
Authorized Official - Middle Name:
Authorized Official - Last Name:WAKEFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-857-5930
Mailing Address - Street 1:PO BOX 197
Mailing Address - Street 2:
Mailing Address - City:ST STEPHENS
Mailing Address - State:WY
Mailing Address - Zip Code:82524
Mailing Address - Country:US
Mailing Address - Phone:307-857-5940
Mailing Address - Fax:307-857-5932
Practice Address - Street 1:11 GREAT PLAINS RD
Practice Address - Street 2:
Practice Address - City:ARAPAHO
Practice Address - State:WY
Practice Address - Zip Code:82510
Practice Address - Country:US
Practice Address - Phone:307-857-5940
Practice Address - Fax:307-857-5932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Not Answered261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Not Answered261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder