Provider Demographics
NPI:1134288046
Name:GALLEGOS, KRISTINE MARIE (LMHC, LPCC)
Entity Type:Individual
Prefix:MS
First Name:KRISTINE
Middle Name:MARIE
Last Name:GALLEGOS
Suffix:
Gender:F
Credentials:LMHC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2905 TOPEKA ST SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-5145
Mailing Address - Country:US
Mailing Address - Phone:978-578-8810
Mailing Address - Fax:
Practice Address - Street 1:2001 SPRING RD
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124
Practice Address - Country:US
Practice Address - Phone:505-994-0364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6560101YM0800X
NM0149471101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health