Provider Demographics
NPI:1538463179
Name:GAINES, BRITTANY R
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:R
Last Name:GAINES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:R
Other - Last Name:CRAWFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3318 S BLACKMAN AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65809-4163
Mailing Address - Country:US
Mailing Address - Phone:417-569-3544
Mailing Address - Fax:
Practice Address - Street 1:3318 S BLACKMAN AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65809-4163
Practice Address - Country:US
Practice Address - Phone:417-569-3544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-22
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional