Provider Demographics
NPI:1780730028
Name:GASTON, PAMELA (MS)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:
Last Name:GASTON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:PAMELA
Other - Middle Name:
Other - Last Name:GASTON-EASTBURG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:8321 VANTARE CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-5412
Mailing Address - Country:US
Mailing Address - Phone:702-338-7411
Mailing Address - Fax:702-471-7411
Practice Address - Street 1:7371 W CHARLESTON BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-1575
Practice Address - Country:US
Practice Address - Phone:702-338-7411
Practice Address - Fax:702-471-7411
Is Sole Proprietor?:No
Enumeration Date:2007-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV00847-L101YA0400X
NV0901106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist