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NPI Code Detail

MEDICARE: DR. JEREMY GALLAS PSY.D.

MEDICARE: DR. JEREMY GALLAS PSY.D.
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
1103TB0200XCognitive & Behavioral PsychologistPY0790NV
2103TC2200XClinical Child & Adolescent PsychologistPY0790NV
3103TC0700XClinical PsychologistPY0790NV
4103TP2701XGroup Psychotherapy PsychologistPY0790NV

General Provider Information

NPI Number : 1851840656
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JEREMY GALLAS PSY.D.
Provider Business Mailing Address
First Line : PO BOX 777117
Second Line :
City : HENDERSON
State : NV
Zip : 89077-7117
Country : US
Telephone Number : 702-824-9639
Fax Number : 725-214-3420
Provider Business Practice Location Address
First Line : 2518 ANTHEM VILLAGE DR STE 103
Second Line :
City : HENDERSON
State : NV
Zip : 89052-5554
Country : US
Telephone Number : 702-824-9639
Fax Number : 725-214-3420
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/22/2016
Last Update Date : 09/28/2023

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