Healthcare Provider Details

I. General information

NPI: 1801306444
Provider Name (Legal Business Name): MICHAEL GALLAGHER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2017
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

183 CALLE MAGDALENA STE 101
ENCINITAS CA
92024-3793
US

IV. Provider business mailing address

PO BOX 651
CARDIFF BY THE SEA CA
92007-0651
US

V. Phone/Fax

Practice location:
  • Phone: 760-546-9572
  • Fax:
Mailing address:
  • Phone: 760-546-9572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC8747
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: