Provider Demographics
NPI:1730650938
Name:GAST, BRIANNA (LCSW, LICSW, LAC)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:
Last Name:GAST
Suffix:
Gender:F
Credentials:LCSW, LICSW, LAC
Other - Prefix:
Other - First Name:BRIANNA
Other - Middle Name:
Other - Last Name:STANGL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:48333 143RD ST
Mailing Address - Street 2:
Mailing Address - City:BIG STONE CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57216-5515
Mailing Address - Country:US
Mailing Address - Phone:605-520-4836
Mailing Address - Fax:
Practice Address - Street 1:450 EASTVOLD AVE
Practice Address - Street 2:
Practice Address - City:ORTONVILLE
Practice Address - State:MN
Practice Address - Zip Code:56278-1133
Practice Address - Country:US
Practice Address - Phone:320-839-6157
Practice Address - Fax:320-839-3851
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN304541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical