Healthcare Provider Details

I. General information

NPI: 1265197875
Provider Name (Legal Business Name): MARIBETH GALLION
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2021
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E MAIN ST STE 201
GRASS VALLEY CA
95945-5853
US

IV. Provider business mailing address

900 E MAIN ST STE 201
GRASS VALLEY CA
95945-5853
US

V. Phone/Fax

Practice location:
  • Phone: 530-273-2244
  • Fax:
Mailing address:
  • Phone: 530-273-2244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: