MEDICARE: KRISTINE DIANE GALLAGHER M.ED., LPC IT

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	101YP2500X	Professional Counselor	7326-226	WI

General Provider Information

NPI Number	:	1467149294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINE DIANE GALLAGHER M.ED., LPC IT

Provider Business Mailing Address
First Line	:	1515 N FLAGLER DR STE 800
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-3431
Country	:	US
Telephone Number	:	800-736-3739
Fax Number	:

Provider Business Practice Location Address
First Line	:	1515 N FLAGLER DR STE 800
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-3431
Country	:	US
Telephone Number	:	800-736-3739
Fax Number	:

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

Provider Enumeration Date	:	04/21/2023
Last Update Date	:	04/21/2023

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