=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285840611
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAROL A GALVAN MFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/15/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3486 TWENTY MILE WAY
-----------------------------------------------------
City | LOVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45140-3202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-583-0995
-----------------------------------------------------
Fax | 513-583-0996
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3486 TWENTY MILE WAY
-----------------------------------------------------
City | LOVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45140-3202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-583-0995
-----------------------------------------------------
Fax | 513-583-0996
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | F077
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------