MEDICARE: MICHAEL GALLESE

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	101YM0800X	Mental Health Counselor	22226	CA
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	R1454740122	CA
3	101YP2500X	Professional Counselor	22226	CA

General Provider Information

NPI Number	:	1720596323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL GALLESE

Provider Business Mailing Address
First Line	:	32158 CAMINO CAPISTRANO STE 104-802
Second Line	:
City	:	SAN JUAN CAPISTRANO
State	:	CA
Zip	:	92675-3720
Country	:	US
Telephone Number	:	424-257-0746
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 S KRAEMER BLVD STE 220
Second Line	:
City	:	PLACENTIA
State	:	CA
Zip	:	92870-6110
Country	:	US
Telephone Number	:	949-257-2249
Fax Number	:

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

Provider Enumeration Date	:	01/17/2018
Last Update Date	:	03/13/2026

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