Provider Demographics
NPI:1073651998
Name:GALLEGOS, JAMES (MFT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:GALLEGOS
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 QUAIL CT
Mailing Address - Street 2:SUITE 206
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-8701
Mailing Address - Country:US
Mailing Address - Phone:925-932-0202
Mailing Address - Fax:925-470-2275
Practice Address - Street 1:43 QUAIL CT
Practice Address - Street 2:SUITE 206
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-8701
Practice Address - Country:US
Practice Address - Phone:925-932-0202
Practice Address - Fax:925-470-2275
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49883101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health