MEDICARE: MRS. BRENDA NATALY GALLARDO LCMHCA

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	A18471	NC

General Provider Information

NPI Number	:	1104522333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BRENDA NATALY GALLARDO LCMHCA

Provider Business Mailing Address
First Line	:	2712 WILD BERRY CT
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-4242
Country	:	US
Telephone Number	:	704-957-6693
Fax Number	:

Provider Business Practice Location Address
First Line	:	2712 WILD BERRY CT
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-4242
Country	:	US
Telephone Number	:	704-957-6693
Fax Number	:

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

Provider Enumeration Date	:	01/31/2023
Last Update Date	:	01/31/2023

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