Provider Demographics
NPI:1508528951
Name:KALLENBERGER, GABRIELLE FAY
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:FAY
Last Name:KALLENBERGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3576 GLASSTOP DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89141-6127
Mailing Address - Country:US
Mailing Address - Phone:210-391-1968
Mailing Address - Fax:
Practice Address - Street 1:8020 W SAHARA AVE STE 125
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-7917
Practice Address - Country:US
Practice Address - Phone:702-470-0620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician