Provider Demographics
NPI:1164745352
Name:GAST, GREGORY EUGENE (MSLMHC)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:EUGENE
Last Name:GAST
Suffix:
Gender:M
Credentials:MSLMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 SADDLETREE TRAIL
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32327
Mailing Address - Country:US
Mailing Address - Phone:850-271-8258
Mailing Address - Fax:850-926-5295
Practice Address - Street 1:3295 CRAWFORDVILLE HWY.
Practice Address - Street 2:SUITE 4
Practice Address - City:CRAWFORDVILLE
Practice Address - State:FL
Practice Address - Zip Code:32327
Practice Address - Country:US
Practice Address - Phone:850-271-8258
Practice Address - Fax:850-926-5295
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-02
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7039101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ026DOtherBCBS