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General NPI Number Information
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NPI Number | 1922268861
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Entity Type | Organization
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Legal Business Name | JOHN T. GALLAGHER AND ASSOCIATES, P.L.C.
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Dates
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Enumeration Date | 06/13/2008
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Last Update Date | 08/29/2008
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Provider Practice Location Address
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Address Line | 6100 NEWPORT RD SUITE 222
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City | PORTAGE
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State | MI
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Zip | 49002-9235
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Country | US
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Telephone | 269-324-1248
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Fax |
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Provider Business Mailing Address
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Address Line | 6100 NEWPORT RD SUITE 222
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City | PORTAGE
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State | MI
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Zip | 49002-9235
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Country | US
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Telephone | 269-324-1248
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST/CO-OWNER
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Name | DR. SHIRLEY A GALLAGHER
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Credential | ED.D.
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Telephone | 269-324-1248
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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