Provider Demographics
NPI:1275067167
Name:GALLEGOS, ESMERALDA MARIN (MA LPC)
Entity Type:Individual
Prefix:MS
First Name:ESMERALDA
Middle Name:MARIN
Last Name:GALLEGOS
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:MS
Other - First Name:ESMERALDA
Other - Middle Name:MARIN
Other - Last Name:GALLEGOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA LPC
Mailing Address - Street 1:2001 HUDSON AVE STE D
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-1889
Mailing Address - Country:US
Mailing Address - Phone:989-906-3171
Mailing Address - Fax:
Practice Address - Street 1:2001 HUDSON AVE STE D
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-1889
Practice Address - Country:US
Practice Address - Phone:989-906-3171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-18
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401017532101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor