Provider Demographics
NPI:1730650938
Name:GAST, BRIANNA (LCSW, LICSW, LAC)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:
Last Name:GAST
Suffix:
Gender:F
Credentials:LCSW, LICSW, LAC
Other - Prefix:
Other - First Name:BRIANNA
Other - Middle Name:
Other - Last Name:STANGL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:818 S BROADWAY STE 113
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-4800
Mailing Address - Country:US
Mailing Address - Phone:605-494-1500
Mailing Address - Fax:
Practice Address - Street 1:818 S BROADWAY STE 113
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-4800
Practice Address - Country:US
Practice Address - Phone:605-494-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN304541041C0700X
SD60561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical