Provider Demographics
NPI:1609036441
Name:GALLAGHER, JOHN PATRICK JR (MED, LMHC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:PATRICK
Last Name:GALLAGHER
Suffix:JR
Gender:M
Credentials:MED, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 E NEW ENGLAND AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-4338
Mailing Address - Country:US
Mailing Address - Phone:407-579-2070
Mailing Address - Fax:
Practice Address - Street 1:114 E NEW ENGLAND AVE STE 1
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-4338
Practice Address - Country:US
Practice Address - Phone:407-579-2070
Practice Address - Fax:407-895-6155
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH4718101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health