Provider Demographics
NPI:1770182081
Name:HASTON, VICTORIA (PLPC)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:HASTON
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1759 E ELM ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65802-3227
Mailing Address - Country:US
Mailing Address - Phone:417-818-8959
Mailing Address - Fax:417-501-1330
Practice Address - Street 1:1759 E ELM ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65802-3227
Practice Address - Country:US
Practice Address - Phone:417-818-8959
Practice Address - Fax:417-501-1330
Is Sole Proprietor?:No
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020033256101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional