Provider Demographics
NPI:1225206451
Name:GASTON, ANGELA RENE (LCSW)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:RENE
Last Name:GASTON
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 1:1230 N DUQUESNE RD
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801-1509
Mailing Address - Country:US
Mailing Address - Phone:417-782-1443
Mailing Address - Fax:417-782-3240
Practice Address - Street 1:1230 N DUQUESNE RD
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-1509
Practice Address - Country:US
Practice Address - Phone:417-782-1443
Practice Address - Fax:417-782-3240
Is Sole Proprietor?:No
Enumeration Date:2008-02-11
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20070287561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical