Provider Demographics
NPI:1609646637
Name:GALLEGO, TOBY SHAWN (MA)
Entity Type:Individual
Prefix:
First Name:TOBY
Middle Name:SHAWN
Last Name:GALLEGO
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 RIVER RD STE F
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-5013
Mailing Address - Country:US
Mailing Address - Phone:458-240-2893
Mailing Address - Fax:
Practice Address - Street 1:2620 RIVER RD STE F
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97404-5013
Practice Address - Country:US
Practice Address - Phone:458-240-2893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health