Provider Demographics
NPI:1366012916
Name:GALLO THERAPY
Entity Type:Organization
Organization Name:GALLO THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LMFT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLO
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:817-454-9683
Mailing Address - Street 1:2808 SADLER AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76133-1822
Mailing Address - Country:US
Mailing Address - Phone:817-454-9683
Mailing Address - Fax:
Practice Address - Street 1:1509 S UNIVERSITY DR STE B212
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-9501
Practice Address - Country:US
Practice Address - Phone:817-454-9683
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-27
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)