Provider Demographics
NPI:1518056365
Name:LJ GALLAGHER PSY D AND ASSOCIATES PLLC
Entity Type:Organization
Organization Name:LJ GALLAGHER PSY D AND ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:GALLAGHER
Authorized Official - Suffix:II
Authorized Official - Credentials:PSYD
Authorized Official - Phone:517-414-0697
Mailing Address - Street 1:PO BOX 722
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:MI
Mailing Address - Zip Code:49230-0722
Mailing Address - Country:US
Mailing Address - Phone:517-414-0697
Mailing Address - Fax:517-938-5914
Practice Address - Street 1:451 MARSHALL ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:MI
Practice Address - Zip Code:49230
Practice Address - Country:US
Practice Address - Phone:517-414-0697
Practice Address - Fax:517-938-5914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P29630Medicare ID - Type Unspecified