Provider Demographics
NPI:1023567831
Name:GALL, DENNIS (PSYD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:GALL
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3761 WINTERSET DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5039
Mailing Address - Country:US
Mailing Address - Phone:907-433-9628
Mailing Address - Fax:
Practice Address - Street 1:4050 LAKE OTIS PKWY STE 105
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5220
Practice Address - Country:US
Practice Address - Phone:907-433-9628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-22
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK174939103T00000X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK174939OtherPSYCHOLOGIST LICENSE