Healthcare Provider Details

I. General information

NPI: 1619702925
Provider Name (Legal Business Name): LATOYA GATEWOOD PLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2024
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 VANDIVER DR
COLUMBIA MO
65202-2094
US

IV. Provider business mailing address

3103 BALLARD MILL DR
COLUMBIA MO
65203-1483
US

V. Phone/Fax

Practice location:
  • Phone: 573-529-1091
  • Fax:
Mailing address:
  • Phone: 573-529-1391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2024035009
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: