MEDICARE: MRS. CAROL WRIGHT GASSER LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	2004008947	MO

General Provider Information

NPI Number	:	1033322490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CAROL WRIGHT GASSER LPC

Provider Business Mailing Address
First Line	:	321 NEWPORT DR
Second Line	:
City	:	SAINT PETERS
State	:	MO
Zip	:	63376-6428
Country	:	US
Telephone Number	:	636-734-1671
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 BOARDWALK SPRINGS PL
Second Line	:	SUITE 111
City	:	O FALLON
State	:	MO
Zip	:	63368-4778
Country	:	US
Telephone Number	:	636-734-1671
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	07/14/2011

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