MEDICARE: THEA GALLAGHER M.S., M.S., LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	PC006687	PA
2	103TC0700X	Clinical Psychologist	024545	NY

General Provider Information

NPI Number	:	1003153511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THEA GALLAGHER M.S., M.S., LPC

Provider Business Mailing Address
First Line	:	247 SUMMIT AVE
Second Line	:
City	:	LANGHORNE
State	:	PA
Zip	:	19047-2215
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	22 S STATE ST
Second Line	:
City	:	NEWTOWN
State	:	PA
Zip	:	18940-3507
Country	:	US
Telephone Number	:	215-579-4116
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2013
Last Update Date	:	04/26/2024

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