Provider Demographics
NPI:1306074638
Name:GAST, ANDREA HUNTER (BCBA)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:HUNTER
Last Name:GAST
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1170 BLUFF RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-6228
Mailing Address - Country:US
Mailing Address - Phone:615-299-6332
Mailing Address - Fax:
Practice Address - Street 1:1170 BLUFF RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-6228
Practice Address - Country:US
Practice Address - Phone:615-299-6332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst