Provider Demographics
NPI:1972109189
Name:GATLIN, SAMANTHA
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:GATLIN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5966 SCOTTSVILLE RD STE 3
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-7908
Mailing Address - Country:US
Mailing Address - Phone:270-904-5104
Mailing Address - Fax:270-201-5980
Practice Address - Street 1:5966 SCOTTSVILLE RD STE 3
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-7908
Practice Address - Country:US
Practice Address - Phone:270-904-5104
Practice Address - Fax:270-201-5980
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-11
Last Update Date:2025-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health