Provider Demographics
NPI:1336570084
Name:MAULDIN, GARY (LMFT)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:
Last Name:MAULDIN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:536 S CREST RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-5917
Mailing Address - Country:US
Mailing Address - Phone:423-619-6312
Mailing Address - Fax:
Practice Address - Street 1:536 S CREST RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-5917
Practice Address - Country:US
Practice Address - Phone:423-619-6312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-05
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN597106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist