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General NPI Number Information
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NPI Number | 1851764625
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Entity Type | Individual
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Provider Name | DAVE R GALLISON LPC
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Gender | Male
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Dates
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Enumeration Date | 11/02/2015
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Last Update Date | 11/02/2015
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Provider Practice Location Address
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Address Line | 1509 SW SUNSET BLVD STE 2G
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City | PORTLAND
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State | OR
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Zip | 97239-2690
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Country | US
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Telephone | 503-704-7796
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Fax |
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Provider Business Mailing Address
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Address Line | 1431 SW WESTWOOD DR
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City | PORTLAND
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State | OR
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Zip | 97239-2754
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Country | US
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Telephone | 503-452-2342
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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 | C0697
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License Number State | OR
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