Active NPI
Daniel G. Gatlin, PH.D., CADC
- Psychologist
- Shepherdsville, KY
National Provider Identifier
1578680344
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 1042
- Practice address
- 130 S Joe B Hall Ave
Shepherdsville, KY 40165-6009 - Phone
- (502) 955-6447
- NPI assigned
- Mar 24, 2007
- Last updated
- Jul 29, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 1042 | KY | Primary |
| Addiction (Substance Use Disorder) Psychologist | 103TA0400X | KY-1042 | KY | |
| Clinical Psychologist | 103TC0700X | KY-1042 | KY |
Addresses
Primary practice location
130 S Joe B Hall Ave
Shepherdsville, KY 40165-6009
Mailing address
101 W Muhammad Ali Blvd
Louisville, KY 40202-1423
Phone (502) 589-8600
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P300014754 | Other | KY | MEDICARE PTAN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| KY-1042 | KY | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Simetria Fall Prevention Centers LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174694400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1469750400000",
"number": "1578680344",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "101 W MUHAMMAD ALI BLVD",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402021423",
"telephone_number": "502-589-8600"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "130 S JOE B HALL AVE",
"city": "SHEPHERDSVILLE",
"state": "KY",
"postal_code": "401656009",
"telephone_number": "502-955-6447"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GATLIN",
"first_name": "DANIEL",
"middle_name": "G.",
"name_prefix": "Dr.",
"credential": "PH.D., CADC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-24",
"last_updated": "2016-07-29",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "KY",
"license": "1042",
"primary": true
},
{
"code": "103TA0400X",
"taxonomy_group": "",
"desc": "Psychologist, Addiction (Substance Use Disorder)",
"state": "KY",
"license": "KY-1042",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "KY",
"license": "KY-1042",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "P300014754",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Shepherdsville, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.