Healthcare Provider Details

I. General information

NPI: 1821890302
Provider Name (Legal Business Name): GALLAHER FAMILY PRACTICE AND ADDICTION RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2025
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1229 TURNPIKE AVE
CLEARFIELD PA
16830-3027
US

IV. Provider business mailing address

1229 TURNPIKE AVE
CLEARFIELD PA
16830-3027
US

V. Phone/Fax

Practice location:
  • Phone: 814-335-5965
  • Fax: 814-205-4042
Mailing address:
  • Phone: 814-335-5965
  • Fax: 814-205-4042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MANDY LYN GALLAHER
Title or Position: FNP-BC
Credential: FNP-BC
Phone: 814-762-0527