Provider Demographics
NPI:1265170203
Name:GATLING, GLEN DANYELL
Entity type:Individual
Prefix:
First Name:GLEN
Middle Name:DANYELL
Last Name:GATLING
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6047 SW 112TH ST
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-9637
Mailing Address - Country:US
Mailing Address - Phone:580-591-1229
Mailing Address - Fax:
Practice Address - Street 1:6047 SW 112TH ST
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-9637
Practice Address - Country:US
Practice Address - Phone:580-591-1229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-20
Last Update Date:2025-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21578-P104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker