Provider Demographics
NPI:1245551043
Name:GATLIN, PATRICIA JANE (LPC, LMFT)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:JANE
Last Name:GATLIN
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:826 RIVIERA DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-3711
Mailing Address - Country:US
Mailing Address - Phone:817-473-4997
Mailing Address - Fax:817-473-4998
Practice Address - Street 1:990 N WALNUT CREEK DR
Practice Address - Street 2:SUITE 2017
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-1580
Practice Address - Country:US
Practice Address - Phone:817-676-3437
Practice Address - Fax:817-473-4998
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-15
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64289101YP2500X
TX201417106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX211847301Medicaid