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General NPI Number Information
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NPI Number | 1063221034
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Entity Type | Organization
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Legal Business Name | GMGPSYCHOLOGY
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Dates
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Enumeration Date | 01/04/2025
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Last Update Date | 01/04/2025
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Provider Practice Location Address
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Address Line | 9930 O LOUGHLIN MANOR AVE
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City | LAS VEGAS
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State | NV
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Zip | 89149-1299
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Country | US
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Telephone | 202-489-1403
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Fax |
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Provider Business Mailing Address
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Address Line | 8414 FARM ROAD STE 180 #1024
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City | LAS VEGAS
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State | NV
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Zip | 89131-8007
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Country | US
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Telephone | 202-489-1403
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL PSYCHOLOGIST
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Name | DR. GRADY MATTHEW GALLAGHER
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Credential | PH.D.
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Telephone | 202-489-1403
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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