Provider Demographics
NPI:1629433768
Name:GALLIPPO, ELSA DENISE (LPC)
Entity Type:Individual
Prefix:MS
First Name:ELSA
Middle Name:DENISE
Last Name:GALLIPPO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:ELSA
Other - Middle Name:GALLIPPO-
Other - Last Name:SEBALY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:215 N 5TH ST APT 6
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-4103
Mailing Address - Country:US
Mailing Address - Phone:906-361-7156
Mailing Address - Fax:
Practice Address - Street 1:347 ROCK ST
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-4725
Practice Address - Country:US
Practice Address - Phone:906-227-9119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-16
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401018196101YP2500X
MI6401015184101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
0P34440Medicare PIN