Doctor Name: | VICKY LYNN GALLEGOS-RANDEL |
NPI Number: | 1114285889 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | 874 |
Business Practice Address: | 607 Division Street Nome, AK - 99762 |
Business Phone Number: | 9074433311 |
Business Fax Number: | 9074435915 |
Mailing Address: | Po Box 966, NOME |
State: | AK |
Postal Code: | 997620966 |
Phone Number: | 9074433311 |
Fax Number: | 9074435915 |
NPI Enumeration Date: | 05/01/2012 |
NPI Last Update Date: | 01/29/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 874 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AK |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |