Provider Demographics
NPI:1811479918
Name:GATLIN, TIFFANY G (LCDC-I)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:G
Last Name:GATLIN
Suffix:
Gender:F
Credentials:LCDC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5401 RAMPART ST APT 529
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-1326
Mailing Address - Country:US
Mailing Address - Phone:832-372-2584
Mailing Address - Fax:713-228-7903
Practice Address - Street 1:5401 RAMPART ST APT 529
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-1326
Practice Address - Country:US
Practice Address - Phone:832-372-2584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25476101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)