MEDICARE: GATEWAY COUNSELING CENTER, INC.

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	101YP2500X	Professional Counselor
2	103T00000X	Psychologist

General Provider Information

NPI Number	:	1962632489
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GATEWAY COUNSELING CENTER, INC.

Provider Business Mailing Address
First Line	:	1864 S KENTWOOD AVE
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65804-2323
Country	:	US
Telephone Number	:	417-869-8400
Fax Number	:	417-869-8401

Provider Business Practice Location Address
First Line	:	1864 S KENTWOOD AVE
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65804-2323
Country	:	US
Telephone Number	:	417-869-8400
Fax Number	:	417-869-8401

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ERNEST GRANT JONES
Credential	:	PHD.
Telephone Number	:	417-869-8400

Provider Enumeration Date	:	07/17/2009
Last Update Date	:	12/04/2018

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