Provider Demographics
NPI:1366138091
Name:WILLIAMS, BRIAN GAGE (MSW, PCSW-1050)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:GAGE
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MSW, PCSW-1050
Other - Prefix:
Other - First Name:GAGE
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, PCSW-1050
Mailing Address - Street 1:141 S CENTER ST STE 314
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2543
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:141 S CENTER ST STE 314
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2543
Practice Address - Country:US
Practice Address - Phone:307-333-4028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-14
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPCSW-10501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical