Healthcare Provider Details

I. General information

NPI: 1912834490
Provider Name (Legal Business Name): GATEWAY HEALTH MEDICAL GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1031 LAMI ST
SAINT LOUIS MO
63104-4216
US

IV. Provider business mailing address

1031 LAMI ST
SAINT LOUIS MO
63104-4216
US

V. Phone/Fax

Practice location:
  • Phone: 314-797-7821
  • Fax:
Mailing address:
  • Phone: 314-797-7821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN SNIPES
Title or Position: OWNER
Credential: MD
Phone: 314-797-7821