=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639356793
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUSAN KAYE GALLOWAY LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2008
-----------------------------------------------------
Last Update Date | 12/13/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 104 MOUND
-----------------------------------------------------
City | TROY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63379
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-697-2747
-----------------------------------------------------
Fax | 573-898-2168
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1191 BROWNSMILL
-----------------------------------------------------
City | ELSBERRY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63343
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-697-2747
-----------------------------------------------------
Fax | 573-898-2168
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | 2007031028
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------