Provider Demographics
NPI:1467789685
Name:GASTON, AMY (LMSW)
Entity Type:Individual
Prefix:MISS
First Name:AMY
Middle Name:
Last Name:GASTON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MISS
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:TARWATER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8000 W 127TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-2714
Mailing Address - Country:US
Mailing Address - Phone:816-508-3300
Mailing Address - Fax:
Practice Address - Street 1:8000 W 127TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-2714
Practice Address - Country:US
Practice Address - Phone:816-508-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-09
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS6027104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker