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NPI Code Detail

MEDICARE: WILLIAM GALLEGO

MEDICARE: WILLIAM GALLEGO
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) Counselor00129NV
2101YM0800XMental Health Counselor00129NV

General Provider Information

NPI Number : 1639556764
Entity Type Code : Individual
Provider Name (Legal Business Name) : WILLIAM GALLEGO
Provider Business Mailing Address
First Line : 3750 E BONANZA RD UNIT 139
Second Line :
City : LAS VEGAS
State : NV
Zip : 89110-6433
Country : US
Telephone Number : 702-812-4189
Fax Number : 702-598-2018
Provider Business Practice Location Address
First Line : 1516 E TROPICANA AVE STE 235
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-8340
Country : US
Telephone Number : 702-812-4189
Fax Number : 702-598-2018
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/27/2015
Last Update Date : 04/27/2015

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Directions to “ WILLIAM GALLEGO ” Practice Location

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