Provider Demographics
NPI:1295504868
Name:GATSON, MARILYN GATSON MARILYN X
Entity type:Individual
Prefix:
First Name:MARILYN GATSON
Middle Name:MARILYN
Last Name:GATSON
Suffix:X
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:STREET NO 1
Mailing Address - Street 2:
Mailing Address - City:MAXICO
Mailing Address - State:MEXICO
Mailing Address - Zip Code:35013
Mailing Address - Country:PK
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:STREET NO 1
Practice Address - Street 2:
Practice Address - City:MAXICO
Practice Address - State:MEXICO
Practice Address - Zip Code:35013
Practice Address - Country:PK
Practice Address - Phone:630-765-3558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-25
Last Update Date:2023-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily