Provider Demographics
NPI:1316217789
Name:GALLARDO-GARIBAY, TATIANA (LPC)
Entity Type:Individual
Prefix:
First Name:TATIANA
Middle Name:
Last Name:GALLARDO-GARIBAY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:471 N MOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-1377
Mailing Address - Country:US
Mailing Address - Phone:541-778-9456
Mailing Address - Fax:
Practice Address - Street 1:33 N CENTRAL AVE STE 307
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-5939
Practice Address - Country:US
Practice Address - Phone:541-778-9456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-03
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
ORC2336101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional