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NPI Code Detail

MEDICARE: MRS. SUSAN MARY GALLAGHER LPC

MEDICARE: MRS. SUSAN MARY GALLAGHER LPC
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
1101YM0800XMental Health Counselor178.015064IL

General Provider Information

NPI Number : 1477212314
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SUSAN MARY GALLAGHER LPC
Provider Business Mailing Address
First Line : 1920 S PASFIELD ST
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62704-3938
Country : US
Telephone Number : 217-220-0521
Fax Number :
Provider Business Practice Location Address
First Line : 2200 S 6TH ST
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62703-3454
Country : US
Telephone Number : 217-698-7150
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/08/2021
Last Update Date : 12/08/2021

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