Healthcare Provider Details

I. General information

NPI: 1972109189
Provider Name (Legal Business Name): SAMANTHA GATLIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2020
Last Update Date: 03/29/2025
Certification Date: 03/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5966 SCOTTSVILLE RD STE 3
BOWLING GREEN KY
42104-7908
US

IV. Provider business mailing address

5966 SCOTTSVILLE RD STE 3
BOWLING GREEN KY
42104-7908
US

V. Phone/Fax

Practice location:
  • Phone: 270-904-5104
  • Fax: 270-201-5980
Mailing address:
  • Phone: 270-904-5104
  • Fax: 270-201-5980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: