MEDICARE: GALLO THERAPY

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1366012916
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GALLO THERAPY

Provider Business Mailing Address
First Line	:	2808 SADLER AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-1822
Country	:	US
Telephone Number	:	817-454-9683
Fax Number	:

Provider Business Practice Location Address
First Line	:	1509 S UNIVERSITY DR STE B212
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-9501
Country	:	US
Telephone Number	:	817-454-9683
Fax Number	:

Authorized Official
Title or Position	:	OWNER/LMFT
Name	:	MRS. ANGELA GALLO
Credential	:	LMFT
Telephone Number	:	817-454-9683

Provider Enumeration Date	:	06/27/2021
Last Update Date	:	07/01/2021

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Directions to “GALLO THERAPY ” Practice Location

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