Provider Demographics
NPI:1093248080
Name:GATSON, TARI LYNETTA (SOCIAL WORKER)
Entity Type:Individual
Prefix:MS
First Name:TARI
Middle Name:LYNETTA
Last Name:GATSON
Suffix:
Gender:F
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7777 S FREEDOM RD
Mailing Address - Street 2:
Mailing Address - City:FRENCH CAMP
Mailing Address - State:CA
Mailing Address - Zip Code:95231
Mailing Address - Country:US
Mailing Address - Phone:209-946-3401
Mailing Address - Fax:209-946-3458
Practice Address - Street 1:7777 S FREEDOM RD
Practice Address - Street 2:
Practice Address - City:FRENCH CAMP
Practice Address - State:CA
Practice Address - Zip Code:95231
Practice Address - Country:US
Practice Address - Phone:209-946-3401
Practice Address - Fax:209-946-3458
Is Sole Proprietor?:No
Enumeration Date:2017-04-06
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW73978104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker