MEDICARE: MS. MARTINA GALLAGHER PMHNP-BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP144519	TX

General Provider Information

NPI Number	:	1972146603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARTINA GALLAGHER PMHNP-BC

Provider Business Mailing Address
First Line	:	PROGRESSIVE BEHAVIORAL HEALTH
Second Line	:	3355 W. ALABAMA, STE 195
City	:	HOUSTON
State	:	TX
Zip	:	77098
Country	:	US
Telephone Number	:	844-824-8775
Fax Number	:

Provider Business Practice Location Address
First Line	:	3355 W ALABAMA ST STE 195
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77098-1722
Country	:	US
Telephone Number	:	844-824-8775
Fax Number	:

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

Provider Enumeration Date	:	10/25/2019
Last Update Date	:	03/16/2020

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