MEDICARE: GABRIELLE SUZANNE GALLET DE ST. AURIN

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

General Provider Information

NPI Number	:	1447827241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIELLE SUZANNE GALLET DE ST. AURIN

Provider Business Mailing Address
First Line	:	3395 W 120TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44111-3565
Country	:	US
Telephone Number	:	704-293-1339
Fax Number	:

Provider Business Practice Location Address
First Line	:	3395 W 120TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44111-3565
Country	:	US
Telephone Number	:	704-293-1339
Fax Number	:

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

Provider Enumeration Date	:	06/09/2021
Last Update Date	:	03/13/2024

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