Provider Demographics
NPI:1487683868
Name:GALLUP, JARIL FAITH (LCSW)
Entity Type:Individual
Prefix:
First Name:JARIL
Middle Name:FAITH
Last Name:GALLUP
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JARIL
Other - Middle Name:FAITH
Other - Last Name:BRANDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:3125 BOEING RD
Mailing Address - Street 2:
Mailing Address - City:CAMERON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:95682-7821
Mailing Address - Country:US
Mailing Address - Phone:847-962-5234
Mailing Address - Fax:847-261-2704
Practice Address - Street 1:3125 BOEING RD
Practice Address - Street 2:
Practice Address - City:CAMERON PARK
Practice Address - State:CA
Practice Address - Zip Code:95682-7821
Practice Address - Country:US
Practice Address - Phone:847-962-5234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1141621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical