Basic Information
| Provider Information | |||||||||
| NPI: | 1669580296 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GALLAGHER | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | PAUL | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | L.C.S.W. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 801 E TAHQUITZ CANYON WAY | ||||||||
| Address2: | 202 | ||||||||
| City: | PALM SPRINGS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922626763 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7603254088 | ||||||||
| FaxNumber: | 7607783781 | ||||||||
| Practice Location | |||||||||
| Address1: | 801 E TAHQUITZ CANYON WAY | ||||||||
| Address2: | 202 | ||||||||
| City: | PALM SPRINGS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922626763 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7603254088 | ||||||||
| FaxNumber: | 7607783781 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2006 | ||||||||
| LastUpdateDate: | 07/28/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 149009132 | IL | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | LCSW66517 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.