Provider Demographics
NPI:1962917617
Name:GATLIN, JOHN WELDON (LCDC)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:WELDON
Last Name:GATLIN
Suffix:
Gender:M
Credentials:LCDC
Other - Prefix:MR
Other - First Name:JAKE
Other - Middle Name:
Other - Last Name:GATLIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCDC
Mailing Address - Street 1:4107 ACORN LN
Mailing Address - Street 2:
Mailing Address - City:PORTER
Mailing Address - State:TX
Mailing Address - Zip Code:77365-9611
Mailing Address - Country:US
Mailing Address - Phone:281-608-7600
Mailing Address - Fax:
Practice Address - Street 1:4107 ACORN LN
Practice Address - Street 2:
Practice Address - City:PORTER
Practice Address - State:TX
Practice Address - Zip Code:77365-9611
Practice Address - Country:US
Practice Address - Phone:281-608-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-04
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12007101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty