Doctor Name: | MICAHEL B GALLAGHER |
NPI Number: | 1528258936 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PSY.D. |
License Number: | 1028 |
Business Practice Address: | 1585 3rd St Fort Polk, LA - 714595102 |
Business Phone Number: | 3185313922 |
Business Fax Number: | |
Mailing Address: | 1585 3rd St, FORT POLK |
State: | LA |
Postal Code: | 714595102 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 07/31/2007 |
NPI Last Update Date: | 07/31/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 1028 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | LA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |