Provider Demographics
NPI:1235771791
Name:CATRON, GIANINA M (MS, LPC)
Entity Type:Individual
Prefix:
First Name:GIANINA
Middle Name:M
Last Name:CATRON
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:GIANINA
Other - Middle Name:M
Other - Last Name:SHIRATO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3322R S CAMPBELL AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-7917
Mailing Address - Country:US
Mailing Address - Phone:417-849-4330
Mailing Address - Fax:
Practice Address - Street 1:3322R S CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-7917
Practice Address - Country:US
Practice Address - Phone:417-849-4330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-16
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00000101YP2500X
MO2020001230101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO490079915Medicaid