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General NPI Number Information
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NPI Number | 1578815510
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Entity Type | Individual
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Provider Name | SUZAN M GALLUCCI M.S., LMHC, BC-TMH
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Gender | Female
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Dates
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Enumeration Date | 10/14/2012
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Last Update Date | 11/04/2021
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Provider Practice Location Address
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Address Line | 1185 IMMOKALEE RD STE 220
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City | NAPLES
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State | FL
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Zip | 34110-4807
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Country | US
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Telephone | 239-860-5789
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Fax |
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Provider Business Mailing Address
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Address Line | 1185 IMMOKALEE RD STE 220
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City | NAPLES
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State | FL
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Zip | 34110-4807
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Country | US
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Telephone | 239-860-5789
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | IMH12150
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH17487
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License Number State | FL
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