Healthcare Provider Details

I. General information

NPI: 1194385369
Provider Name (Legal Business Name): JACOB GALLES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2019
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1694 HAIGHT ST
SAN FRANCISCO CA
94117-2816
US

IV. Provider business mailing address

1694 HAIGHT ST
SAN FRANCISCO CA
94117-2816
US

V. Phone/Fax

Practice location:
  • Phone: 561-790-1191
  • Fax:
Mailing address:
  • Phone: 828-606-3809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY36493
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY10029
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number5960
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: