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NPI Code Detail

MEDICARE: TONY DEON GILLON JR. M.ED., LPC

MEDICARE: TONY DEON GILLON JR. M.ED., 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
1101YM0800XMental Health Counselor2018040871MO
2101YS0200XSchool Counselor2018040871MO
3101YP2500XProfessional Counselor2018040871MO

General Provider Information

NPI Number : 1891448981
Entity Type Code : Individual
Provider Name (Legal Business Name) : TONY DEON GILLON JR. M.ED., LPC
Provider Business Mailing Address
First Line : 5319 SHAW AVE
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63110-3023
Country : US
Telephone Number : 314-378-3433
Fax Number :
Provider Business Practice Location Address
First Line : 5319 SHAW AVE
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63110-3023
Country : US
Telephone Number : 314-378-3433
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/31/2022
Last Update Date : 01/31/2022

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