Healthcare Provider Details

I. General information

NPI: 1326465915
Provider Name (Legal Business Name): ALYSSA GALLAGHER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2014
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11145 TAMPA AVE STE 12B
PORTER RANCH CA
91326-2215
US

IV. Provider business mailing address

11145 TAMPA AVE STE 12B
PORTER RANCH CA
91326-2215
US

V. Phone/Fax

Practice location:
  • Phone: 818-336-1644
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY36004
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY1110
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: