Provider Demographics
NPI:1114140670
Name:G'SELL, TONJA RENEE (LCSW)
Entity Type:Individual
Prefix:
First Name:TONJA
Middle Name:RENEE
Last Name:G'SELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 MUNICIPAL DR
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MO
Mailing Address - Zip Code:63010-1012
Mailing Address - Country:US
Mailing Address - Phone:636-296-6206
Mailing Address - Fax:636-296-0102
Practice Address - Street 1:21 MUNICIPAL DR
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MO
Practice Address - Zip Code:63010-1012
Practice Address - Country:US
Practice Address - Phone:636-296-6206
Practice Address - Fax:636-296-0102
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20040321301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO499373603Medicaid