Provider Demographics
NPI:1790113314
Name:MUSGRAVE-GASSAWAY, LINDA M (LPC)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:M
Last Name:MUSGRAVE-GASSAWAY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6813 ENGLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:RAYTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:64133-6119
Mailing Address - Country:US
Mailing Address - Phone:816-803-7573
Mailing Address - Fax:
Practice Address - Street 1:6813 ENGLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:RAYTOWN
Practice Address - State:MO
Practice Address - Zip Code:64133-6119
Practice Address - Country:US
Practice Address - Phone:816-803-7573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-16
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013015424101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional