Healthcare Provider Details

I. General information

NPI: 1518896042
Provider Name (Legal Business Name): JACLYN GATESY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

357 TANGER BLVD STE 215
SEYMOUR IN
47274-3597
US

IV. Provider business mailing address

357 TANGER BLVD STE 215
SEYMOUR IN
47274-3597
US

V. Phone/Fax

Practice location:
  • Phone: 615-905-9217
  • Fax: 812-522-0291
Mailing address:
  • Phone: 615-905-9217
  • Fax: 812-522-0291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number88001343A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: