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General NPI Number Information
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NPI Number | 1316270861
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Entity Type | Individual
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Provider Name | MATTHEW GALLO MA, LPC
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Gender | Male
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Dates
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Enumeration Date | 09/16/2009
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Last Update Date | 09/16/2009
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Provider Practice Location Address
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Address Line | 900 NORTH SHORE DR 120
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City | LAKE BLUFF
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State | IL
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Zip | 60044-2243
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Country | US
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Telephone | 847-615-1698
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Fax |
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Provider Business Mailing Address
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Address Line | 656 PEARSON ST 708
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City | DES PLAINES
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State | IL
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Zip | 60016-4629
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Country | US
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Telephone | 708-724-5668
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 178005934
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License Number State | IL
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