Provider Demographics
NPI:1316117666
Name:GATES, KATINA M (BS)
Entity type:Individual
Prefix:MRS
First Name:KATINA
Middle Name:M
Last Name:GATES
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 N CHILD ST
Mailing Address - Street 2:
Mailing Address - City:OKOLONA
Mailing Address - State:MS
Mailing Address - Zip Code:38860-1505
Mailing Address - Country:US
Mailing Address - Phone:662-447-0335
Mailing Address - Fax:
Practice Address - Street 1:216 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MS
Practice Address - Zip Code:38843-1148
Practice Address - Country:US
Practice Address - Phone:662-862-5014
Practice Address - Fax:662-844-0780
Is Sole Proprietor?:No
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health