Healthcare Provider Details

I. General information

NPI: 1235837469
Provider Name (Legal Business Name): NICOLE ASHLIE GALLEGOS AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2023
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

724 YAKIMA AVE
TACOMA WA
98405-4864
US

IV. Provider business mailing address

724 YAKIMA AVE
TACOMA WA
98405-4864
US

V. Phone/Fax

Practice location:
  • Phone: 253-356-8459
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: