Provider Demographics
NPI:1194202556
Name:GALLEGOS COUNSELING, LLC
Entity Type:Organization
Organization Name:GALLEGOS COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLEGOS
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:641-781-0770
Mailing Address - Street 1:1404 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:GRINNELL
Mailing Address - State:IA
Mailing Address - Zip Code:50112-1421
Mailing Address - Country:US
Mailing Address - Phone:641-781-0770
Mailing Address - Fax:
Practice Address - Street 1:807 4TH AVE
Practice Address - Street 2:
Practice Address - City:GRINNELL
Practice Address - State:IA
Practice Address - Zip Code:50112-2042
Practice Address - Country:US
Practice Address - Phone:641-781-0770
Practice Address - Fax:641-316-8178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-27
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0083681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1740240456OtherTYPE 1 NPI
CA18431OtherLCSW LICENSE
IA008368OtherLISW LICENSE