Provider Demographics
NPI:1578445664
Name:GARGIS, KATLYN
Entity type:Individual
Prefix:
First Name:KATLYN
Middle Name:
Last Name:GARGIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATLYN
Other - Middle Name:
Other - Last Name:HAYNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:120 W DUNBAR CAVE RD STE AB
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-6774
Mailing Address - Country:US
Mailing Address - Phone:931-538-3252
Mailing Address - Fax:
Practice Address - Street 1:120 W DUNBAR CAVE RD STE AB
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-6774
Practice Address - Country:US
Practice Address - Phone:931-538-3252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-22
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician