Provider Demographics
NPI:1649748294
Name:GALLMEIER, JOSEPH BRIAN (MA, LADC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:BRIAN
Last Name:GALLMEIER
Suffix:
Gender:M
Credentials:MA, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 W BROADWAY AVE STE 2&3
Mailing Address - Street 2:
Mailing Address - City:FOREST LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55025-1175
Mailing Address - Country:US
Mailing Address - Phone:651-777-5222
Mailing Address - Fax:
Practice Address - Street 1:555 W BROADWAY AVE STE 2&3
Practice Address - Street 2:
Practice Address - City:FOREST LAKE
Practice Address - State:MN
Practice Address - Zip Code:55025-1175
Practice Address - Country:US
Practice Address - Phone:651-251-5237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-12
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN304187101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)