Provider Demographics
NPI:1235184391
Name:GALLAGHER, GREGORY F (CSW LLPC)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:F
Last Name:GALLAGHER
Suffix:
Gender:M
Credentials:CSW LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 N WEST AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202
Mailing Address - Country:US
Mailing Address - Phone:517-780-3336
Mailing Address - Fax:517-796-4561
Practice Address - Street 1:1200 N WEST AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202
Practice Address - Country:US
Practice Address - Phone:517-780-3336
Practice Address - Fax:517-796-4561
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801033871104100000X
MI6301003768104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI8008970890OtherTRADITIONAL BCBS
MI054330OtherVALUE OPTIONS STATE OF MI