Healthcare Provider Details

I. General information

NPI: 1174286322
Provider Name (Legal Business Name): ERICA LOVE GATLIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2021
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8623 E 32ND ST N
WICHITA KS
67226-3317
US

IV. Provider business mailing address

2607 CADDO ST STE 6
ARKADELPHIA AR
71923-5307
US

V. Phone/Fax

Practice location:
  • Phone: 316-869-2888
  • Fax: 316-425-5550
Mailing address:
  • Phone: 870-230-8217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number03783
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: