Provider Demographics
NPI:1225741341
Name:GALLAGHER, ASHLEY J (MA, AMFT)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:J
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:MA, AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1626 PIERCE ST APT 422
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-5228
Mailing Address - Country:US
Mailing Address - Phone:415-302-2064
Mailing Address - Fax:
Practice Address - Street 1:1346 4TH ST STE 202
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-2860
Practice Address - Country:US
Practice Address - Phone:415-326-6354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-04
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA136376106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist