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General NPI Number Information
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NPI Number | 1649976192
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Entity Type | Individual
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Provider Name | BEAU GALLUCCI ROOTRING LPC
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Gender | Female
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Dates
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Enumeration Date | 02/06/2023
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Last Update Date | 02/06/2023
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Provider Practice Location Address
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Address Line | 7750 MONTGOMERY RD STE 110
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City | CINCINNATI
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State | OH
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Zip | 45236-4257
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Country | US
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Telephone | 513-520-3959
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Fax |
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Provider Business Mailing Address
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Address Line | 3515 BROOKWOOD MDWS
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City | CINCINNATI
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State | OH
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Zip | 45208-4257
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Country | US
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Telephone | 513-520-3959
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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 | C.2204703
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License Number State | OH
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