Provider Information for 1073382586
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Ms. MATTIE GATES BUSH LMFT
Other Names:Other Name:Mrs. MATTIE GLEN GATES NASex: Female
NPI: 1073382586
Last Updated: 2023-12-26
Certification Date: 2023-12-21
Certification Date: 2023-12-21
Details
Name | Value | ||||||||
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NPI | 1073382586 | ||||||||
Enumeration Date | 2023-12-26 | ||||||||
NPI Type | NPI-1 Individual | ||||||||
Sole Proprietor | YES | ||||||||
Status | Active | ||||||||
Mailing Address | 37 SHARP ST FORSYTH, GA 31029-1721 United States Phone: 478-361-9774 | Fax: | ||||||||
Primary Practice Address | 37 SHARP ST FORSYTH, GA 31029-1721 United States Phone: 478-361-9774 | Fax: | ||||||||
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