Organization Name: | WITH EAGLES WINGS |
NPI Number: | 1801869169 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | LEON WAKEFIELD (DIRECTOR OF WITH EAGLES WINGS) |
Mailing Address: | 11 Great Plains Rd Arapaho |
State: | WY US |
Postal Code: | 82510 |
Phone Number: | 3078575940 |
Fax Number: | 3078575932 |
NPI Enumeration Date: | 02/08/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | X |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |