MEDICARE: DIANE E GALLINGER MFT

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	106H00000X	Marriage & Family Therapist	MFT20047	CA

General Provider Information

NPI Number	:	1275708448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE E GALLINGER MFT

Provider Business Mailing Address
First Line	:	6117 BROCKTON AVE STE 102
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92506-2282
Country	:	US
Telephone Number	:	951-686-0223
Fax Number	:

Provider Business Practice Location Address
First Line	:	6117 BROCKTON AVE STE 102
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92506-2282
Country	:	US
Telephone Number	:	951-686-0223
Fax Number	:

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

Provider Enumeration Date	:	04/28/2008
Last Update Date	:	04/28/2008

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Directions to “ DIANE E GALLINGER MFT” Practice Location

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