Healthcare Provider Details

I. General information

NPI: 1962653931
Provider Name (Legal Business Name): MICHAEL CHRISTOPHER GALLO PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2008
Last Update Date: 10/07/2021
Certification Date: 10/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

981 W 3RD AVE
EUGENE OR
97402-4924
US

IV. Provider business mailing address

981 W 3RD AVE
EUGENE OR
97402-4924
US

V. Phone/Fax

Practice location:
  • Phone: 707-616-6126
  • Fax:
Mailing address:
  • Phone: 707-616-6126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: