Provider Demographics
NPI:1033497151
Name:GASTON, LATONYA REASHAWN (CPC-INTERN)
Entity Type:Individual
Prefix:
First Name:LATONYA
Middle Name:REASHAWN
Last Name:GASTON
Suffix:
Gender:F
Credentials:CPC-INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 COUNTRY GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-4707
Mailing Address - Country:US
Mailing Address - Phone:702-439-9358
Mailing Address - Fax:
Practice Address - Street 1:1001 COUNTRY GROVE AVE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-4707
Practice Address - Country:US
Practice Address - Phone:702-439-9358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-22
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225400000X
NVCI0133101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional