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NPI Code Detail

MEDICARE: MR. JOSEPH THOMAS GASTON SR. BA, LCDCIII

MEDICARE: MR. JOSEPH THOMAS GASTON SR. BA, LCDCIII
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
1101YA0400XAddiction (Substance Use Disorder) Counselor111116OH

General Provider Information

NPI Number : 1164935516
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JOSEPH THOMAS GASTON SR. BA, LCDCIII
Provider Business Mailing Address
First Line : 6001 WOODLAND AVE STE 703
Second Line :
City : CLEVELAND
State : OH
Zip : 44104-2775
Country : US
Telephone Number : 216-431-2018
Fax Number : 216-431-2023
Provider Business Practice Location Address
First Line : 6001 WOODLAND AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44104-2762
Country : US
Telephone Number : 216-431-2018
Fax Number : 216-431-2023
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/08/2017
Last Update Date : 11/08/2017

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