Provider Demographics
NPI:1205540507
Name:GATON, KIARA JUDEA
Entity type:Individual
Prefix:
First Name:KIARA
Middle Name:JUDEA
Last Name:GATON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2741 CAMERON WAY
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75181-4405
Mailing Address - Country:US
Mailing Address - Phone:214-803-8602
Mailing Address - Fax:
Practice Address - Street 1:2741 CAMERON WAY
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75181-4405
Practice Address - Country:US
Practice Address - Phone:214-803-8602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX687741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical