MEDICARE: LESLEY M GALLACHER CACII

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	ACB.0008218	CO

General Provider Information

NPI Number	:	1861902975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLEY M GALLACHER CACII

Provider Business Mailing Address
First Line	:	220 RUSKIN DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80910-2522
Country	:	US
Telephone Number	:	719-572-6100
Fax Number	:

Provider Business Practice Location Address
First Line	:	6071 E WOODMEN RD STE 145
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80923-2609
Country	:	US
Telephone Number	:	719-572-6100
Fax Number	:

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

Provider Enumeration Date	:	10/03/2017
Last Update Date	:	10/03/2017

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