Healthcare Provider Details

I. General information

NPI: 1548486806
Provider Name (Legal Business Name): ANDERSON GALLAHER & ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 12/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 THAIN RD SUITE F
LEWISTON ID
83501-5300
US

IV. Provider business mailing address

450 THAIN RD SUITE F
LEWISTON ID
83501-5300
US

V. Phone/Fax

Practice location:
  • Phone: 208-743-0150
  • Fax: 208-743-5358
Mailing address:
  • Phone: 208-743-0150
  • Fax: 208-743-5358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY-202154
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLCPC2976
License Number StateID

VIII. Authorized Official

Name: DR. RICHARD BALLOU GALLAHER JR.
Title or Position: OWNER
Credential: PHD
Phone: 208-743-0150