MEDICARE: ANGELA GALLO LMFT

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	106H00000X	Marriage & Family Therapist	203072	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	55555	OTHER		N/A

General Provider Information

NPI Number	:	1457941486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA GALLO LMFT

Provider Business Mailing Address
First Line	:	2808 SADLER AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-1822
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2808 SADLER AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-1822
Country	:	US
Telephone Number	:	817-454-9683
Fax Number	:

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

Provider Enumeration Date	:	01/23/2021
Last Update Date	:	01/23/2021

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Directions to “ ANGELA GALLO LMFT” Practice Location

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