Provider Demographics
NPI:1386153716
Name:GATI, JASON DAVID (MED, LPCA, NCC)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:DAVID
Last Name:GATI
Suffix:
Gender:M
Credentials:MED, LPCA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 N MAIN ST STE 103A
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-3451
Mailing Address - Country:US
Mailing Address - Phone:270-506-5604
Mailing Address - Fax:
Practice Address - Street 1:360 WATERFOWL LOOP
Practice Address - Street 2:
Practice Address - City:RINEYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40162-9473
Practice Address - Country:US
Practice Address - Phone:516-991-9618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-28
Last Update Date:2017-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY128881101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health