Provider Demographics
NPI:1154912517
Name:BOTTOM, GINA F (MMFT)
Entity type:Individual
Prefix:MRS
First Name:GINA
Middle Name:F
Last Name:BOTTOM
Suffix:
Gender:F
Credentials:MMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 N HUME AVE
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-2916
Mailing Address - Country:US
Mailing Address - Phone:580-695-1261
Mailing Address - Fax:
Practice Address - Street 1:7015 CONCORD RD
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-6606
Practice Address - Country:US
Practice Address - Phone:615-625-2058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
TN1836101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health