1669580296 NPI number — MR. JOHN PAUL GALLAGHER L.C.S.W.

Table of content: ADESUWA AIBANGBEE NP (NPI 1396039871)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669580296 NPI number — MR. JOHN PAUL GALLAGHER L.C.S.W.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GALLAGHER
Provider First Name:
JOHN
Provider Middle Name:
PAUL
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
L.C.S.W.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669580296
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/28/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
801 E TAHQUITZ CANYON WAY
Provider Second Line Business Mailing Address:
202
Provider Business Mailing Address City Name:
PALM SPRINGS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92262-6763
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-325-4088
Provider Business Mailing Address Fax Number:
760-778-3781

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 E TAHQUITZ CANYON WAY
Provider Second Line Business Practice Location Address:
202
Provider Business Practice Location Address City Name:
PALM SPRINGS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92262-6763
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-325-4088
Provider Business Practice Location Address Fax Number:
760-778-3781
Provider Enumeration Date:
08/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  149009132 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: LCSW66517 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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