Healthcare Provider Details

I. General information

NPI: 1669580296
Provider Name (Legal Business Name): JOHN PAUL GALLAGHER L.C.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 07/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 E TAHQUITZ CANYON WAY 202
PALM SPRINGS CA
92262-6763
US

IV. Provider business mailing address

801 E TAHQUITZ CANYON WAY 202
PALM SPRINGS CA
92262-6763
US

V. Phone/Fax

Practice location:
  • Phone: 760-325-4088
  • Fax: 760-778-3781
Mailing address:
  • Phone: 760-325-4088
  • Fax: 760-778-3781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149009132
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW66517
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: