Provider Demographics
NPI:1275931974
Name:GALLAGHER, COURTNEY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1554 N EMERSON ST UNIT 4
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1450
Mailing Address - Country:US
Mailing Address - Phone:720-336-1477
Mailing Address - Fax:
Practice Address - Street 1:1554 N EMERSON ST UNIT 4
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1450
Practice Address - Country:US
Practice Address - Phone:720-336-1477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-11
Last Update Date:2021-04-09
Deactivation Date:2021-01-29
Deactivation Code:
Reactivation Date:2021-02-26
Provider Licenses
StateLicense IDTaxonomies
COPSY.0005431101YM0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health