Healthcare Provider Details

I. General information

NPI: 1700633922
Provider Name (Legal Business Name): MEGAN GALLOWAY AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2024
Last Update Date: 05/06/2024
Certification Date: 05/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 S FAIR OAKS AVE STE 310
PASADENA CA
91105-2012
US

IV. Provider business mailing address

1263 E TOPEKA ST
PASADENA CA
91104-1459
US

V. Phone/Fax

Practice location:
  • Phone: 626-319-2287
  • Fax:
Mailing address:
  • Phone: 213-268-5772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAMFT144859
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: