Provider Demographics
NPI:1619352598
Name:GATTON, JERRY LYNN JR
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:LYNN
Last Name:GATTON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7668
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98507-7668
Mailing Address - Country:US
Mailing Address - Phone:360-709-9725
Mailing Address - Fax:360-570-8848
Practice Address - Street 1:309 WASHINGTON ST NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-1144
Practice Address - Country:US
Practice Address - Phone:360-709-9725
Practice Address - Fax:360-570-8848
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-21
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health