Provider Demographics
NPI:1639150584
Name:TESTER, GARY LYNN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:LYNN
Last Name:TESTER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3621 GLEN OAKS DRIVE
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37412
Mailing Address - Country:US
Mailing Address - Phone:423-867-5290
Mailing Address - Fax:
Practice Address - Street 1:1406 BROADRICK DRIVE
Practice Address - Street 2:WESTCOTT OUTPATIENT
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720
Practice Address - Country:US
Practice Address - Phone:706-272-6560
Practice Address - Fax:706-272-6560
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5861041C0700X
GA14311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
R08898Medicare UPIN
TN3693930Medicare ID - Type Unspecified
GA80BBDWPMedicare ID - Type Unspecified