Provider Demographics
NPI:1548286636
Name:GATTON, REBECCA LYNN (MS, LPC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNN
Last Name:GATTON
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:LYNN
Other - Last Name:KINGBURY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13432 ELMWOOD DR STE 209
Mailing Address - Street 2:
Mailing Address - City:BAXTER
Mailing Address - State:MN
Mailing Address - Zip Code:56425-8538
Mailing Address - Country:US
Mailing Address - Phone:218-839-9421
Mailing Address - Fax:
Practice Address - Street 1:13432 ELMWOOD DR STE 209
Practice Address - Street 2:
Practice Address - City:BAXTER
Practice Address - State:MN
Practice Address - Zip Code:56425-8538
Practice Address - Country:US
Practice Address - Phone:218-839-9421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN00024101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional