Healthcare Provider Details

I. General information

NPI: 1760614549
Provider Name (Legal Business Name): ALICIA K GATTI LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALICIA K MULLEN IMF

II. Dates (important events)

Enumeration Date: 08/13/2009
Last Update Date: 06/14/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E MORGAN ST
JACKSONVILLE IL
62650-2587
US

IV. Provider business mailing address

710 N 8TH ST
SPRINGFIELD IL
62702-6324
US

V. Phone/Fax

Practice location:
  • Phone: 217-371-3897
  • Fax:
Mailing address:
  • Phone: 217-525-1064
  • Fax: 217-525-1651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number166001020
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: