MEDICARE: ELIZABETH GALLION MS MAED LASAC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	13255	AZ

General Provider Information

NPI Number	:	1699100552
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH GALLION MS MAED LASAC

Provider Business Mailing Address
First Line	:	9303 GILCREASE AVE UNIT 1019
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-6102
Country	:	US
Telephone Number	:	702-769-9052
Fax Number	:

Provider Business Practice Location Address
First Line	:	4626 W ENGLISH DR
Second Line	:
City	:	GOLDEN VALLEY
State	:	AZ
Zip	:	86413-8238
Country	:	US
Telephone Number	:	928-565-2460
Fax Number	:

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

Provider Enumeration Date	:	09/11/2013
Last Update Date	:	09/11/2013

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