=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467887919
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ESPERANZA VERNADRES GALLON MA, PCC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/03/2013
-----------------------------------------------------
Last Update Date | 04/20/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11223 CORNELL PARK DR STE 102
-----------------------------------------------------
City | BLUE ASH
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45242-1835
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-982-2442
-----------------------------------------------------
Fax | 513-982-2424
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11223 CORNELL PARK DR STE 102
-----------------------------------------------------
City | BLUE ASH
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45242-1835
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-982-2525
-----------------------------------------------------
Fax | 513-982-2424
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 39004239A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | E.1200060
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------