MEDICARE: MARBI L GALLAWAY MA

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	101YM0800X	Mental Health Counselor	LPC-12555	AZ

General Provider Information

NPI Number	:	1053541144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARBI L GALLAWAY MA

Provider Business Mailing Address
First Line	:	5701 N BLACK CANYON HWY
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85015-2208
Country	:	US
Telephone Number	:	602-448-6369
Fax Number	:	602-978-8572

Provider Business Practice Location Address
First Line	:	5701 N BLACK CANYON HWY
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85015-2208
Country	:	US
Telephone Number	:	602-448-6369
Fax Number	:	602-978-8572

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

Provider Enumeration Date	:	07/22/2009
Last Update Date	:	07/22/2009

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