Healthcare Provider Details

I. General information

NPI: 1720297625
Provider Name (Legal Business Name): NICOLE R GALBERTH M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 05/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 N MAIN AVE SUITE 201
GRESHAM OR
97030-7242
US

IV. Provider business mailing address

245 SE CLEVELAND AVE
GRESHAM OR
97080-8065
US

V. Phone/Fax

Practice location:
  • Phone: 971-678-8226
  • Fax:
Mailing address:
  • Phone: 971-678-8226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC3131
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: