MEDICARE: MS. ELAINE DENISE GASTON LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	49800	CA

General Provider Information

NPI Number	:	1538325949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELAINE DENISE GASTON LMFT

Provider Business Mailing Address
First Line	:	712 WILCREST DRIVE
Second Line	:	PMB 1061
City	:	HOUSTON
State	:	TX
Zip	:	77042-1348
Country	:	US
Telephone Number	:	626-644-0660
Fax Number	:

Provider Business Practice Location Address
First Line	:	712 WILCREST DR # 1061
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77042-1348
Country	:	US
Telephone Number	:	626-644-0660
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2008
Last Update Date	:	04/04/2023

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