Provider Demographics
NPI:1679744049
Name:GALLERY, ELIZABETH (MFT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:GALLERY
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 E ORTEGA ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93103-2529
Mailing Address - Country:US
Mailing Address - Phone:805-963-2878
Mailing Address - Fax:
Practice Address - Street 1:1125 E ORTEGA ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93103-2529
Practice Address - Country:US
Practice Address - Phone:805-963-2878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24433106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist