Provider Demographics
NPI:1659068260
Name:GATLIN, TEVIN
Entity Type:Individual
Prefix:
First Name:TEVIN
Middle Name:
Last Name:GATLIN
Suffix:
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 1:2655 UNION HALL RD APT A10
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-8444
Mailing Address - Country:US
Mailing Address - Phone:731-217-5780
Mailing Address - Fax:
Practice Address - Street 1:2655 UNION HALL RD APT A10
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-8444
Practice Address - Country:US
Practice Address - Phone:731-217-5780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRBT-23-261939106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician