Individual
JACQUELYNN GASTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, PLPC
Contact information
Practice address
10830 SAINT CHARLES ROCK RD, SAINT ANN, MO 63074-1508
(314) 368-2409
Mailing address
523 SAPPHIRE DR, O FALLON, MO 63366-1889
(314) 368-2409
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
2021028262
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2021028262
INSURANCE
MO
Enumeration date
10/03/2022
Last updated
03/21/2023
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