Provider Demographics
NPI:1548587686
Name:GASS, MATHEW CARL (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MATHEW
Middle Name:CARL
Last Name:GASS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 E YERBY ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MO
Mailing Address - Zip Code:65340-2319
Mailing Address - Country:US
Mailing Address - Phone:660-831-5098
Mailing Address - Fax:
Practice Address - Street 1:527 E YERBY ST
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MO
Practice Address - Zip Code:65340-2319
Practice Address - Country:US
Practice Address - Phone:660-831-5098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20080350901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical