Provider Demographics
NPI:1790004067
Name:PLUMMER, GWENDA MARIE (LPC)
Entity type:Individual
Prefix:DR
First Name:GWENDA
Middle Name:MARIE
Last Name:PLUMMER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:GWENDA
Other - Middle Name:LASSETER
Other - Last Name:PLUMMER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:2315 HIGHWAY K
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-8659
Mailing Address - Country:US
Mailing Address - Phone:417-773-9410
Mailing Address - Fax:
Practice Address - Street 1:2315 HIGHWAY K
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-8659
Practice Address - Country:US
Practice Address - Phone:417-773-9410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-25
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006038838101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional