Jacquelynn Gaston, MA, PLPC
Individual provider Active NPI Mental Health Counselor · Saint Ann, MO
NPI 1609590710 · NPPES record last updated Mar 21, 2023
Key facts
- NPI
- 1609590710
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- 2021028262 (MO)
- Practice address
- 10830 Saint Charles Rock Rd
Saint Ann, MO 63074-1508 - Phone
- (314) 368-2409
- NPI assigned
- Oct 3, 2022
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2021028262 | MO | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Changes Therapeutics Services | Current |
Accepting new patients | |
| Alpine'S Empowerment Agency, PLLC | Mental Health | Past | Accepting new patients |
Locations
12 Fee Fee Rd
Maryland Heights, MO 63043
Phone (314) 368-2409
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 2021028262 | MO | Yes |
Addresses
Primary practice location
10830 Saint Charles Rock Rd
Saint Ann, MO 63074-1508
Mailing address
523 Sapphire Dr
O Fallon, MO 63366-1889
Phone (314) 368-2409
Other practice location 1
12 Fee Fee Rd
Maryland Heights, MO 63043-2729
Phone (314) 368-2409
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2021028262 | Other | MO | INSURANCE |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | changestherapy@yahoo.com | Direct |
Other providers in Saint Ann, MO
- Terrell Matthew Fisher
- Fleetmedicalsupplinc
- Susan W Foster
- Full Care Life
- Tonya Gaither
- Adrain Gillispie
- Peter Gontarz
- Gordon Private Care, LLC
- Dianne Gsell
- Kathryn Haile
All providers in Saint Ann, MO · Mental Health Counselor in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 21, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.