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General NPI Number Information
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NPI Number | 1710302898
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Entity Type | Individual
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Provider Name | GERARD MONDESTIN MA, LPC
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Gender | Male
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Dates
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Enumeration Date | 02/25/2014
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Last Update Date | 08/05/2025
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Provider Practice Location Address
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Address Line | 5620 W WILDWOOD RANCH PKWY
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City | JOPLIN
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State | MO
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Zip | 64804-4520
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Country | US
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Telephone | 417-623-1990
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Fax | 417-623-9931
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Provider Business Mailing Address
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Address Line | 900 E LAHARPE ST
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City | KIRKSVILLE
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State | MO
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Zip | 63501-4520
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 7124
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2013043958
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License Number State | MO
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