MEDICARE: MRS. SILVIA TERESA GALLO VAZQUEZ LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LPC11801	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LISAC10617	OTHER	AZ	THERAPIST
2	LPC11801	OTHER	AZ	THERAPIST

General Provider Information

NPI Number	:	1104998533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SILVIA TERESA GALLO VAZQUEZ LPC

Provider Business Mailing Address
First Line	:	13415 W CITRUS CT
Second Line	:
City	:	LITCHIFIELD PARK
State	:	AZ
Zip	:	85340
Country	:	US
Telephone Number	:	602-999-7898
Fax Number	:	480-820-7863

Provider Business Practice Location Address
First Line	:	5745 W CAMPBELL AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85031-1842
Country	:	US
Telephone Number	:	602-999-7898
Fax Number	:	480-820-7863

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	12/06/2011

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