Provider Demographics
NPI:1477228450
Name:GASTON, KRISTA LAW
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:LAW
Last Name:GASTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:458 HERNDON ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4859
Mailing Address - Country:US
Mailing Address - Phone:318-213-1860
Mailing Address - Fax:318-227-6179
Practice Address - Street 1:458 HERNDON ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4859
Practice Address - Country:US
Practice Address - Phone:318-213-1860
Practice Address - Fax:318-227-6179
Is Sole Proprietor?:No
Enumeration Date:2021-08-12
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16411104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker