Provider Demographics
NPI:1083198832
Name:GASTON, MARQUIS A
Entity Type:Individual
Prefix:
First Name:MARQUIS
Middle Name:A
Last Name:GASTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1049 HASSELL AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-2321
Mailing Address - Country:US
Mailing Address - Phone:702-272-6355
Mailing Address - Fax:
Practice Address - Street 1:6551 MCCARRAN ST APT 3091
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89086-1448
Practice Address - Country:US
Practice Address - Phone:214-940-4240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor