Healthcare Provider Details

I. General information

NPI: 1467149294
Provider Name (Legal Business Name): KRISTINE DIANE GALLAGHER M.ED., LPC IT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2023
Last Update Date: 04/21/2023
Certification Date: 04/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 N FLAGLER DR STE 800
WEST PALM BEACH FL
33401-3431
US

IV. Provider business mailing address

1515 N FLAGLER DR STE 800
WEST PALM BEACH FL
33401-3431
US

V. Phone/Fax

Practice location:
  • Phone: 800-736-3739
  • Fax:
Mailing address:
  • Phone: 800-736-3739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7326-226
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: