Basic Information
| Provider Information | |||||||||
| NPI: | 1003377011 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GATEWAY RECOVERY CLINIC, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 805 ALEXA DR STE D | ||||||||
| Address2: | |||||||||
| City: | MT STERLING | ||||||||
| State: | KY | ||||||||
| PostalCode: | 403531000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8594328002 | ||||||||
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| Practice Location | |||||||||
| Address1: | 805 ALEXA DR STE D | ||||||||
| Address2: | |||||||||
| City: | MT STERLING | ||||||||
| State: | KY | ||||||||
| PostalCode: | 403531000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8594328002 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2019 | ||||||||
| LastUpdateDate: | 06/18/2019 | ||||||||
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| AuthorizedOfficialLastName: | ZALONE | ||||||||
| AuthorizedOfficialFirstName: | SARAH | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 8594328002 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.