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NPI Code Detail

MEDICARE: RICHARD LAURENT GALLOIS III

MEDICARE: RICHARD LAURENT GALLOIS III
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
1101YA0400XAddiction (Substance Use Disorder) CounselorCDCA.186384OH

General Provider Information

NPI Number : 1487425278
Entity Type Code : Individual
Provider Name (Legal Business Name) : RICHARD LAURENT GALLOIS III
Provider Business Mailing Address
First Line : 2332 W MCMICKEN AVE
Second Line :
City : CINCINNATI
State : OH
Zip : 45214-1817
Country : US
Telephone Number : 513-633-1040
Fax Number :
Provider Business Practice Location Address
First Line : 7058 CORPORATE WAY STE 3
Second Line :
City : DAYTON
State : OH
Zip : 45459-4243
Country : US
Telephone Number : 513-377-9374
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/11/2024
Last Update Date : 01/11/2024

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Directions to “ RICHARD LAURENT GALLOIS III ” Practice Location

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