Healthcare Provider Details

I. General information

NPI: 1710302898
Provider Name (Legal Business Name): GERARD MONDESTIN PHD, MA, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2014
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5620 W WILDWOOD RANCH PKWY
JOPLIN MO
64804-4520
US

IV. Provider business mailing address

900 E LAHARPE ST
KIRKSVILLE MO
63501-4520
US

V. Phone/Fax

Practice location:
  • Phone: 417-623-1990
  • Fax: 417-623-9931
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2013043958
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: