Healthcare Provider Details

I. General information

NPI: 1780665687
Provider Name (Legal Business Name): OMEGA JODEAN GALLIANO M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8350 W SAHARA AVE SUITE 130
LAS VEGAS NV
89117-8939
US

IV. Provider business mailing address

9413 DREW CT
LAS VEGAS NV
89117-7273
US

V. Phone/Fax

Practice location:
  • Phone: 702-258-5711
  • Fax: 702-258-1304
Mailing address:
  • Phone: 702-258-5711
  • Fax: 702-258-1304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number619
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP0146
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0551
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: