Healthcare Provider Details

I. General information

NPI: 1144139163
Provider Name (Legal Business Name): GAIL WILLDEN LPC, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1138 BIRCHGATE TRL
SAINT LOUIS MO
63135-1332
US

IV. Provider business mailing address

1138 BIRCHGATE TRL
SAINT LOUIS MO
63135-1332
US

V. Phone/Fax

Practice location:
  • Phone: 575-707-3481
  • Fax:
Mailing address:
  • Phone: 575-707-3481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB-2022-0347
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2025052943
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: