Healthcare Provider Details

I. General information

NPI: 1023929296
Provider Name (Legal Business Name): COLLEEN GALLAGHER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 SIXTH ST
TRAVERSE CITY MI
49684-2386
US

IV. Provider business mailing address

7555 E HOXIE RD
CEDAR MI
49621-9571
US

V. Phone/Fax

Practice location:
  • Phone: 231-492-7031
  • Fax:
Mailing address:
  • Phone: 231-492-7031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801118270
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: