MEDICARE: ALYSSA GALLAGHER

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	103T00000X	Psychologist	PSY36004	CA
2	103T00000X	Psychologist	PY1110	NV

General Provider Information

NPI Number	:	1326465915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA GALLAGHER

Provider Business Mailing Address
First Line	:	11145 TAMPA AVE STE 12B
Second Line	:
City	:	PORTER RANCH
State	:	CA
Zip	:	91326-2215
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11145 TAMPA AVE STE 12B
Second Line	:
City	:	PORTER RANCH
State	:	CA
Zip	:	91326-2215
Country	:	US
Telephone Number	:	818-336-1644
Fax Number	:

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

Provider Enumeration Date	:	03/21/2014
Last Update Date	:	05/07/2026

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Directions to “ ALYSSA GALLAGHER ” Practice Location

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