Provider Demographics
NPI:1558825968
Name:GALLO, MASHANNA (LPC)
Entity Type:Individual
Prefix:
First Name:MASHANNA
Middle Name:
Last Name:GALLO
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 1:650 POYDRAS STREET
Mailing Address - Street 2:SUITE 1400 PMB0879
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70130
Mailing Address - Country:US
Mailing Address - Phone:504-321-1751
Mailing Address - Fax:877-479-2005
Practice Address - Street 1:650 POYDRAS ST STE 1400
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70130-6116
Practice Address - Country:US
Practice Address - Phone:504-321-1751
Practice Address - Fax:877-479-2005
Is Sole Proprietor?:No
Enumeration Date:2019-01-30
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7695101YP2500X
LAPLC7695171M00000X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA464235889Medicaid